Kimberly Jaye Daffron-Baker, LCSW,LPC-S,LMFT,LCDC
Individual provider Active NPI Social Worker · Bulverde, TX
NPI 1962592402 · NPPES record last updated Apr 10, 2020
Key facts
- NPI
- 1962592402
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 62456 (TX)
- Practice address
- 29710 US Highway 281 N
Bulverde, TX 78163-3107 - Phone
- (210) 896-6215
- NPI assigned
- Oct 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2016
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
29710 US Hwy 281 N
Bulverde, TX 78163-3107
Phone (210) 896-6215
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200428001773 | TX | Practitioner - Clinical Social Worker | 0446680789 | Practice locations: Bulverde, TX |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12532 | TX | MD | Addiction (Substance Use Disorder) Counselor |
| 72729 | TX | MD | Professional Counselor |
| 202430 | TX | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Emdr Group of South Texas, PLLC | Current |
Accepting new patients |
Locations
29710 US Highway 281 N
Bulverde, TX 78163
Phone (210) 500-2278
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 12532 | TX | |
| Professional Counselor | 101YP2500X | 72729 | TX | |
| Marriage & Family Therapist | 106H00000X | 202430 | TX | |
| Social Worker | 104100000X | 62456 | TX | Yes |
Addresses
Primary practice location
29710 US Highway 281 N
Bulverde, TX 78163-3107
Mailing address
25806 Santolina
San Antonio, TX 78261-2672
Phone (210) 896-6215
Other providers in Bulverde, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.