Provider Demographics
NPI:1841060738
Name:DAVILA, KIMBERLY (LSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:DAVILA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7149 ERDRICK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-1012
Mailing Address - Country:US
Mailing Address - Phone:215-495-3757
Mailing Address - Fax:
Practice Address - Street 1:7149 ERDRICK ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-1012
Practice Address - Country:US
Practice Address - Phone:215-495-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
PASW140392104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker