Provider Demographics
NPI:1346969912
Name:HEENAN, KIMBERLEE RENE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEE
Middle Name:RENE
Last Name:HEENAN
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 1:3 HUGHES LN
Mailing Address - Street 2:
Mailing Address - City:GREENLAND
Mailing Address - State:NH
Mailing Address - Zip Code:03840-2358
Mailing Address - Country:US
Mailing Address - Phone:603-475-2118
Mailing Address - Fax:
Practice Address - Street 1:3 HUGHES LN
Practice Address - Street 2:
Practice Address - City:GREENLAND
Practice Address - State:NH
Practice Address - Zip Code:03840-2358
Practice Address - Country:US
Practice Address - Phone:603-475-2118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1500OtherLICSW