Basic Information
| Provider Information | |||||||||
| NPI: | 1093050486 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CENA | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 812 E JOLLY RD | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489106818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173468000 | ||||||||
| FaxNumber: | 5173468291 | ||||||||
| Practice Location | |||||||||
| Address1: | 838 LOUISA ST | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489110214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178875257 | ||||||||
| FaxNumber: | 5178875273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2012 | ||||||||
| LastUpdateDate: | 12/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801089814 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.