Provider Demographics
NPI:1073194445
Name:TRAHAN, KIMBERLY (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ELAINE WAY
Mailing Address - Street 2:
Mailing Address - City:ACUSHNET
Mailing Address - State:MA
Mailing Address - Zip Code:02743-1624
Mailing Address - Country:US
Mailing Address - Phone:774-929-0001
Mailing Address - Fax:
Practice Address - Street 1:708 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:ACUSHNET
Practice Address - State:MA
Practice Address - Zip Code:02743-1409
Practice Address - Country:US
Practice Address - Phone:774-929-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2175061041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool