Provider Demographics
NPI:1225526312
Name:ESTES, KIMBERLY ANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:ESTES
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 1:38 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-6612
Mailing Address - Country:US
Mailing Address - Phone:603-359-5084
Mailing Address - Fax:
Practice Address - Street 1:2458 CHRISTIAN STREET
Practice Address - Street 2:
Practice Address - City:WILDER
Practice Address - State:VT
Practice Address - Zip Code:05088
Practice Address - Country:US
Practice Address - Phone:603-359-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01193711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical