Cynthia Louise Kimball, LMSW, ACSW, ACHP-SW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801063302 Issued in MI

Practice address

640 3 Mile Rd NW
Suite 101
Grand Rapids, MI 49544-8209

Phone

(616) 785-8900

Fax

(616) 785-8949

NPI assigned

Dec 7, 2012

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 MI

Eligible to order & refer

• Part B services: No
• 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

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

{
    "created_epoch": "1354838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354838400000",
    "number": "1699010298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 3 MILE RD NW",
            "address_2": "SUITE 101",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495448209",
            "telephone_number": "616-785-8900",
            "fax_number": "616-785-8949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 3 MILE RD NW",
            "address_2": "SUITE 101",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495448209",
            "telephone_number": "616-785-8900",
            "fax_number": "616-785-8949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "CYNTHIA",
        "middle_name": "LOUISE",
        "name_prefix": "Ms.",
        "credential": "LMSW, ACSW, ACHP-SW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-12-07",
        "last_updated": "2012-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801063302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joy Hee-Kyung Kim, CRNA
• Maria Kim, DO
• Roderick Kim, M.D.
• Sean Seungwon Won Kim, DO
• Andrew Scott Kimball, M.D.
• Thomas R Kimball, DDS
• Kimber Decker Counseling and Consultation PLLC
• Kimberly Lichon-Tufer
• Elaina Marie Kimbrell, LMSW
• Angelia Kimbrough

• Clinical Social Worker in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2012; 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.