Provider Demographics
NPI:1962592402
Name:DAFFRON-BAKER, KIMBERLY JAYE (LCSW,LPC-S,LMFT,LCDC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JAYE
Last Name:DAFFRON-BAKER
Suffix:
Gender:F
Credentials:LCSW,LPC-S,LMFT,LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25806 SANTOLINA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2672
Mailing Address - Country:US
Mailing Address - Phone:210-896-6215
Mailing Address - Fax:
Practice Address - Street 1:29710 US HIGHWAY 281 N
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-3107
Practice Address - Country:US
Practice Address - Phone:210-896-6215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12532101YA0400X
TX72729101YP2500X
TX202430106H00000X
TX62456104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist