Provider Demographics
NPI:1437505294
Name:DIMBERG, KRISTIN LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:LYNN
Last Name:DIMBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:MONTOUR FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14865
Mailing Address - Country:US
Mailing Address - Phone:860-391-3677
Mailing Address - Fax:802-488-6919
Practice Address - Street 1:401 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:MONTOUR FALLS
Practice Address - State:NY
Practice Address - Zip Code:14865
Practice Address - Country:US
Practice Address - Phone:802-488-6934
Practice Address - Fax:802-488-6919
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-01098541041C0700X
NY0868361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical