Provider Demographics
NPI:1063482685
Name:KLIMM, MARYLOUISE (LICSW)
Entity Type:Individual
Prefix:
First Name:MARYLOUISE
Middle Name:
Last Name:KLIMM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 RANSOM RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-1655
Mailing Address - Country:US
Mailing Address - Phone:508-548-2860
Mailing Address - Fax:508-495-0795
Practice Address - Street 1:354 GIFFORD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2950
Practice Address - Country:US
Practice Address - Phone:508-566-1405
Practice Address - Fax:508-495-0795
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1031581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO06339Medicare ID - Type Unspecified