Mary Lynette Kimble, SWT

Primary specialty

Social WorkerTaxonomy code 104100000X

License

S.2403415-TRNE Issued in OH

Practice address

21625 Chagrin Blvd
Beachwood, OH 44122-5363

Phone

(216) 343-8069

NPI assigned

Jan 30, 2024

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

Other names 1

• Mary Lynette Hampton Former name

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": "1706572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1912760372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5672 VICKIE LN",
            "city": "BEDFORD HTS",
            "state": "OH",
            "postal_code": "441462415",
            "telephone_number": "216-343-8069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21625 CHAGRIN BLVD",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225363",
            "telephone_number": "216-343-8069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBLE",
        "first_name": "MARY",
        "middle_name": "LYNETTE",
        "credential": "SWT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-30",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "S.2403415-TRNE",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.2403415-TRNE",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "HAMPTON",
            "middle_name": "LYNETTE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joseph S Khouri, M.D.
• Elizabeth R. Khuri, MA,LPC
• Carrie A Kiepert, APRN,FNP-BC
• Young Shin Kim, M.D.
• Ariel Kimak
• Taif Kinani, BDS
• Anne Margaret Kinchen
• King David Aquatic Center LLC
• King David Home Health LLC
• King David Post Acute Nursing & Rehabilitation LLC

• Social Worker in Beachwood, OH
• Providers in Beachwood, OH by specialty
• Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; 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.