Individual
SUSAN KIMERIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
713 W NEW YORK AVE STE 202, DELAND, FL 32720-5201
(386) 624-6812
(386) 401-2446
Mailing address
713 W NEW YORK AVE STE 202, DELAND, FL 32720-5201
(386) 624-6812
(386) 401-2446
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
FL
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112829500
—
FL
05
—
113844300
—
FL
05
—
116025500
—
FL
Enumeration date
09/28/2021
Last updated
04/15/2025
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