Provider Demographics
NPI:1447215595
Name:KIMBALL, CHRISTINE C (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:C
Last Name:KIMBALL
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:BOX 118
Mailing Address - Street 2:
Mailing Address - City:WHITEFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04353
Mailing Address - Country:US
Mailing Address - Phone:207-549-5622
Mailing Address - Fax:
Practice Address - Street 1:79 SCHOONER ST
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4051
Practice Address - Country:US
Practice Address - Phone:207-294-4657
Practice Address - Fax:207-294-4649
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC62081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8698Medicare UPIN