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KIMBERLY AVANNGELINE PENNYBROOK LICSW
NPI 1770021685
Social Worker - Clinical in Poulsbo, WA

Active since February 10, 2017Opted out of Medicare · through Jan 1, 2027
18978 FRONT ST NE # B, POULSBO, WA 98370(253) 372-2412 Get Directions Write a Review

NPPES record last updated: February 5, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Feb 5, 2024, May 25, 2021, Feb 10, 2017 (3 updates tracked since 2017).

About Kimberly Avanngeline Pennybrook Licsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIMBERLY AVANNGELINE PENNYBROOK LICSW (NPI 1770021685) is an individual clinical provider in Poulsbo, Washington, licensed in Washington (LW60682845) and active in the NPI registry since February 2017. She has opted out of Medicare through January 1, 2027.

NPPES Registry Identity

NPI1770021685
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameKIMBERLY AVANNGELINE PENNYBROOKCredential: LICSW
Location Address18978 FRONT ST NE # BPoulsbo, WA 98370-7353
Mailing Address20283 1st Ave Ne, A-5Poulsbo, WA 98370-9047 · (253) 372-2412
Phone(253) 372-2412
Sole ProprietorNo
Enumeration DateFebruary 10, 2017
Last NPPES UpdateFebruary 5, 20243 updates tracked since enumeration
NPPES CertifiedJanuary 15, 2024
✔ NPI 1770021685 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in WA · LW60682845
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
18978 FRONT ST NE # B, Poulsbo, WA 98370
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Other Names 1

Former Name (1)Kimberly Ann Burke Licsw

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include PacificSource Health Plans, Premera Blue Cross Blue Shield of Alaska.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Kimberly Avanngeline Pennybrook Licsw has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2025 through January 1, 2027.

Opt-Out Effective DateJanuary 1, 2025
Opt-Out In Effect ThroughJanuary 1, 2027Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kimberly Pennybrook's NPI number?

The NPI number for Kimberly Pennybrook is 1770021685. It was assigned to this individual provider in the NPPES registry on February 10, 2017. The provider is also known as Kimberly Ann Burke Licsw.

Where is Kimberly Pennybrook located?

Kimberly Pennybrook practices at 18978 Front St NE # B, Poulsbo, WA 98370. The listed phone number is (253) 372-2412.

What is Kimberly Pennybrook's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Kimberly Pennybrook enrolled in Medicare?

No. Kimberly Pennybrook has opted out of Medicare through January 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

What insurance does Kimberly Pennybrook accept?

Health plans from PacificSource Health Plans and Premera Blue Cross Blue Shield of Alaska list Kimberly Pennybrook as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kimberly Pennybrook was last updated on February 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.