Provider Demographics
NPI:1588460141
Name:ZIEMER, KELLY LYNN (LCSW)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNN
Last Name:ZIEMER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20187 BUTTERMERE CT
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-7607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SARPHATISTRAAT 14
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NOORD HOLLAND
Practice Address - Zip Code:1017 WS
Practice Address - Country:NL
Practice Address - Phone:707-408-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0984131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical