Provider Demographics
NPI:1083021653
Name:WHITTEMORE, KIMBERLY ALICE (BA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ALICE
Last Name:WHITTEMORE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ALICE
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 CROSBY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820
Mailing Address - Country:US
Mailing Address - Phone:603-516-9300
Mailing Address - Fax:603-743-3244
Practice Address - Street 1:50 CHESTNUT STREET
Practice Address - Street 2:SUITE A
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820
Practice Address - Country:US
Practice Address - Phone:603-516-9300
Practice Address - Fax:603-516-2731
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical