Provider Demographics
NPI:1609902832
Name:SAPOLIS, KIMBERLY ANN (LSW)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:ANN
Last Name:SAPOLIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-4560
Mailing Address - Country:US
Mailing Address - Phone:570-709-3314
Mailing Address - Fax:570-383-0063
Practice Address - Street 1:650 BOULEVARD AVE
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1710
Practice Address - Country:US
Practice Address - Phone:570-383-2799
Practice Address - Fax:570-383-0063
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW124593104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker