Provider Demographics
NPI:1619194149
Name:KAZIMOUR, KIMBERLY (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:KAZIMOUR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 SW 50TH WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-3824
Mailing Address - Country:US
Mailing Address - Phone:352-335-2945
Mailing Address - Fax:352-335-2419
Practice Address - Street 1:4040 W NEWBERRY RD
Practice Address - Street 2:SUITE 1350
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-5503
Practice Address - Country:US
Practice Address - Phone:352-335-2945
Practice Address - Fax:352-335-2419
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0001949101YM0800X
FLSS0000325103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3721213OtherAETNA
306886OtherAVMED
Z2768OtherBCBS