Provider Demographics
NPI:1073831855
Name:GILES, KIM C (LICSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:C
Last Name:GILES
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 1:8 WESTON WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03223-4952
Mailing Address - Country:US
Mailing Address - Phone:603-913-9174
Mailing Address - Fax:603-913-1974
Practice Address - Street 1:8 WESTON WOODS CIR
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03223-4952
Practice Address - Country:US
Practice Address - Phone:603-913-1974
Practice Address - Fax:603-536-2180
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30422235Medicaid