Provider Demographics
NPI:1003422940
Name:KIMBLE, CHARLES R (LSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:KIMBLE
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ELM TER
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-3170
Mailing Address - Country:US
Mailing Address - Phone:908-875-8329
Mailing Address - Fax:
Practice Address - Street 1:22 ELM TER
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-3170
Practice Address - Country:US
Practice Address - Phone:908-875-8329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSW-GTL-20-012691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical