Provider Demographics
NPI:1023393147
Name:ELLIOTT, KIMBERLY (LCSW-R)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 VINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12306-2918
Mailing Address - Country:US
Mailing Address - Phone:518-355-3810
Mailing Address - Fax:
Practice Address - Street 1:1213 VINEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12306-2918
Practice Address - Country:US
Practice Address - Phone:518-355-3810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0306321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical