Provider Demographics
NPI:1558845552
Name:BIGELOW, KIM MARIE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:MARIE
Last Name:BIGELOW
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:HOULIHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:HAYDEN MCFADDEN SCHOOL
Mailing Address - Street 2:361 CEDAR GROVE ST
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02746
Mailing Address - Country:US
Mailing Address - Phone:508-997-4511
Mailing Address - Fax:
Practice Address - Street 1:HAYDEN MCFADDEN SCHOOL
Practice Address - Street 2:361 CEDAR GROVE ST
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02746
Practice Address - Country:US
Practice Address - Phone:508-997-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1111521041C0700X
MA1132446101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical