Provider Demographics
NPI:1316254980
Name:MUNTZ, KIMBERLY M (LMSW)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:M
Last Name:MUNTZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 INDUSTRIAL DR
Mailing Address - Street 2:STE 4
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1741
Mailing Address - Country:US
Mailing Address - Phone:734-944-8300
Mailing Address - Fax:
Practice Address - Street 1:1235 INDUSTRIAL DR
Practice Address - Street 2:SUITE 4
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1741
Practice Address - Country:US
Practice Address - Phone:734-944-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010939561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical