Provider Demographics
NPI:1003507260
Name:KIMSU MARDER, PMHNP-BC, CCM, PLLC
Entity Type:Organization
Organization Name:KIMSU MARDER, PMHNP-BC, CCM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KIMSU
Authorized Official - Middle Name:
Authorized Official - Last Name:MARDER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, CCM
Authorized Official - Phone:978-853-4019
Mailing Address - Street 1:110 HAVERHILL RD STE 455
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2123
Mailing Address - Country:US
Mailing Address - Phone:978-853-4019
Mailing Address - Fax:978-792-5782
Practice Address - Street 1:110 HAVERHILL RD STE 455
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2123
Practice Address - Country:US
Practice Address - Phone:978-853-4019
Practice Address - Fax:978-792-5782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty