Kimberly Marie Black, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2019005809 Issued in MO

Practice address

400 N Washington St Ste 130B
Farmington, MO 63640-1764

Phone

(573) 944-0591

NPI assigned

Jan 26, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683158400000",
    "number": "1215528955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N WASHINGTON ST STE 130B",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636401764",
            "telephone_number": "573-944-0591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N WASHINGTON ST STE 130B",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636401764",
            "telephone_number": "573-944-0591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KIMBERLY",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-26",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2019005809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• BJC Behavioral Health
• BJC Behavioral Health
• BJC Behavioral Health
• BJC Home Care Services (BJC Home Medical Equipment)
• Emily Marie Black
• Laurie Lee Black, LCSW
• Nicole Black
• Diana Ruth Blocker
• Bloom Speech Therapy Services, LLC
• Rebecca Jean Bloom, B.S.ED.

• Clinical Social Worker in Farmington, MO
• Providers in Farmington, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.