Kimberly Avanngeline Pennybrook, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW60682845 Issued in WA

Practice address

18978 Front St NE # B
Poulsbo, WA 98370-7353

Phone

(253) 372-2412

NPI assigned

Feb 10, 2017

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

Other names 1

• Kimberly Ann Burke Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2025 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Kyle McKenzie DC Inc

  • Chiropractor
  • Silverdale, WA
  • NPI 1487254645
  NPD (past)
• Madrona Institute of Washington

  • Addiction (Substance Use Disorder) Counselor
  • Port Townsend, WA
  • NPI 1154410876
  NPD (past)
• MCS Counseling Group LLC

  • Mental Health Counselor
  • Silverdale, WA
  • NPI 1740727494
  NPD (past)
• Summit Health Management PLLC

  • Professional Counselor
  • Gig Harbor, WA
  • NPI 1508467564
  NPD (past)

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

{
    "created_epoch": "1486684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707091200000",
    "number": "1770021685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20283 1ST AVE NE",
            "address_2": "A-5",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983709047",
            "telephone_number": "253-372-2412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18978 FRONT ST NE # B",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983707353",
            "telephone_number": "253-372-2412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNYBROOK",
        "first_name": "KIMBERLY",
        "middle_name": "AVANNGELINE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-10",
        "last_updated": "2024-02-05",
        "certification_date": "2024-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60682845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "BURKE",
            "middle_name": "ANN",
            "credential": "LICSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Peninsula Community Health Services
• Peninsula Community Health Services
• Peninsula Community Health Services
• Peninsula Counseling Center LLC
• Peninsula Hearing Inc
• Glenn Adam Peterson, PA-C
• Jeromy A Peterson, DDS PS
• Madeleine Peterson
• Patricia Lynn Pettapiece, D.C.
• Anthony Hoai-Nam Pham, MD

• Clinical Social Worker in Poulsbo, WA
• Providers in Poulsbo, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.