Provider Demographics
NPI:1811917776
Name:WOODWORTH, KIMBERLEY (MSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 LA JOLLA VILLAGE DR # S118
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-0002
Mailing Address - Country:US
Mailing Address - Phone:858-642-3181
Mailing Address - Fax:858-552-4311
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR # 118S
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0002
Practice Address - Country:US
Practice Address - Phone:858-642-3181
Practice Address - Fax:858-552-4311
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS102981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical