Provider Demographics
NPI:1679880397
Name:COMITO, KIMBERLY P (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:P
Last Name:COMITO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15212 W POND WOODS DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1836
Mailing Address - Country:US
Mailing Address - Phone:813-395-2488
Mailing Address - Fax:
Practice Address - Street 1:15212 W POND WOODS DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1836
Practice Address - Country:US
Practice Address - Phone:813-395-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW97541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW9754OtherCLINICAL SOCIAL WORK LICENSE