Provider Demographics
NPI:1326265513
Name:KIMBALL, LUCIA ANN (RN, LMHC)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:ANN
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:RN, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-7618
Mailing Address - Country:US
Mailing Address - Phone:978-373-1236
Mailing Address - Fax:
Practice Address - Street 1:131 RANTOUL ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-4240
Practice Address - Country:US
Practice Address - Phone:978-921-1293
Practice Address - Fax:978-921-1294
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA986101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health