Kimberly Nissim, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW022172 Issued in PA

Practice address

345 Montgomery Ave
Bala Cynwyd, PA 19004-2801

Phone

(267) 788-5025

NPI assigned

Aug 23, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1471910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1639624315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 MONTGOMERY AVE",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190042801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 MONTGOMERY AVE",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190042801",
            "telephone_number": "267-788-5025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSIM",
        "first_name": "KIMBERLY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-23",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW022172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katina Nguyen, DDS
• Nice and Noble Solutions LLC
• Lynn Nicholas
• Kameil Lee Nicholson, LCSW
• Nicos Nicolaou, M.D.
• Noor Stone Home Care
• Northeastern Eyecare Network
• Angela Raqual Norward
• Noubar a. Didizian M.D.
• Noubar Didizian M.D.

• Clinical Social Worker in Bala Cynwyd, PA
• Providers in Bala Cynwyd, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; 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.