Provider Demographics
NPI:1386828952
Name:ADDESSO, KIMBERLY RUTH (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:RUTH
Last Name:ADDESSO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 RYMROCK RD UNIT 49
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-7458
Mailing Address - Country:US
Mailing Address - Phone:845-532-4994
Mailing Address - Fax:845-334-4972
Practice Address - Street 1:131 RYMROCK RD UNIT 49
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-7458
Practice Address - Country:US
Practice Address - Phone:845-532-4994
Practice Address - Fax:845-334-4972
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0578111104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker