Provider Demographics
NPI:1366782385
Name:GILLES, KIMBERLY ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:GILLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:BERTSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 898
Mailing Address - Street 2:
Mailing Address - City:RICHLANDTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18955-0898
Mailing Address - Country:US
Mailing Address - Phone:215-272-9642
Mailing Address - Fax:215-536-1059
Practice Address - Street 1:1534 WEST BRAD STREET
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1106
Practice Address - Country:US
Practice Address - Phone:215-272-9642
Practice Address - Fax:215-536-1059
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0173951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW017395OtherLCSW CREDENTIALS