Provider Demographics
NPI:1083365506
Name:ZARA, KIMBERLY JOAN (LMSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOAN
Last Name:ZARA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CALDERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-6100
Mailing Address - Country:US
Mailing Address - Phone:518-332-7181
Mailing Address - Fax:
Practice Address - Street 1:116 CALDERWOOD RD
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-6100
Practice Address - Country:US
Practice Address - Phone:518-332-7181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063479101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health