Kimberly F Waibogha, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

DP00939057 Issued in WV

Practice address

930 Chestnut Ridge Rd
Morgantown, WV 26505-2807

Phone

(304) 598-4214

NPI assigned

Nov 9, 2009

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wellbrook Behavioral Health Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Columbia, MD
  • NPI 1487220281

  Clinical

  NPD (past) Authorized official
• Change Health Systems, Inc

  • Community/Behavioral Health Agency
  • Baltimore, MD
  • NPI 1558414862
  NPD

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

{
    "created_epoch": "1257724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257724800000",
    "number": "1245567536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 780",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265070780",
            "telephone_number": "304-293-7401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 CHESTNUT RIDGE RD",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265052807",
            "telephone_number": "304-598-4214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAIBOGHA",
        "first_name": "KIMBERLY",
        "middle_name": "F",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-09",
        "last_updated": "2009-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WV",
            "license": "DP00939057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Wagner, MA
• Jason Blair Wagner, APRN, FNP-C
• Kathryn Wagner
• Reginna L Wagoner, BCBA
• Noah Wahler, MH-PRSS
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2083)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-3215)
• Wal-Mart Stores East, LP (Vision Center 30-2083)
• Wal-Mart Stores East, LP (Vision Center 30-3215)
• Walgreen Co (Walgreens #21269)

• Clinical Social Worker in Morgantown, WV
• Providers in Morgantown, WV by specialty
• Clinical Social Worker in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.