Provider Demographics
NPI:1184631590
Name:SHARPE, KIMBERLY S (MA, LADC)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:S
Last Name:SHARPE
Suffix:
Gender:F
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169171 LAKEVIEW TERRACE
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482
Mailing Address - Country:US
Mailing Address - Phone:203-426-5704
Mailing Address - Fax:203-426-5704
Practice Address - Street 1:72 NORTH ST STE 202
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5653
Practice Address - Country:US
Practice Address - Phone:203-770-7269
Practice Address - Fax:203-426-5704
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00290101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00290OtherLICENSED ALCOHOL AND DRUG
CT300000290CT01OtherBLUE CROSS BLUE SHIELD