Kim Lynette Braxton, LCSW
Individual provider Active NPI Clinical Social Worker · Patton, CA
NPI 1699809707 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1699809707
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Practice address
- 3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369 - Phone
- (909) 425-7000
- Fax
- (909) 620-9793
- NPI assigned
- Mar 14, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23535 | CA | MD | Anesthesiology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 23535 | CA | |
| Clinical Social Worker | 1041C0700X | Yes |
Addresses
Primary practice location
3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369
Mailing address
3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369
Phone (909) 425-7000
Other providers in Patton, CA
- Mina Beshara
- Nancy Ann Blacketer
- Andrew C Blaine
- Matthew Bonn
- Sean P Brannon
- William Gordon Britt III
- Robert Edward Brodie
- Felicia Ann Brown
- Hong (Rose) Bui
- Melanie Ann Byde
All providers in Patton, CA · Clinical Social Worker in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.