Provider Demographics
NPI:1154674695
Name:KIM COMERFORD LLC
Entity Type:Organization
Organization Name:KIM COMERFORD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEE
Authorized Official - Middle Name:F
Authorized Official - Last Name:COMERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-458-2799
Mailing Address - Street 1:43 MICHAELSON DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1355
Mailing Address - Country:US
Mailing Address - Phone:609-458-2799
Mailing Address - Fax:
Practice Address - Street 1:6 WHITE HORSE PIKE
Practice Address - Street 2:SUITE 1B
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1246
Practice Address - Country:US
Practice Address - Phone:609-458-2799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC011730001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ232855YF6MMedicare PIN