Provider Demographics
NPI:1760363154
Name:KIM, CALEB (PHD, MSW, MDIV, LCSW)
Entity type:Individual
Prefix:DR
First Name:CALEB
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHD, MSW, MDIV, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 WILD TIMOTHY RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4357
Mailing Address - Country:US
Mailing Address - Phone:630-276-9188
Mailing Address - Fax:
Practice Address - Street 1:2708 WILD TIMOTHY RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4357
Practice Address - Country:US
Practice Address - Phone:630-276-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490299691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty