Provider Demographics
NPI:1598252058
Name:DENNISON, KIMBERLY N (MSW-CC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:N
Last Name:DENNISON
Suffix:
Gender:F
Credentials:MSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-3304
Mailing Address - Country:US
Mailing Address - Phone:207-596-0359
Mailing Address - Fax:207-596-0350
Practice Address - Street 1:375 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-3304
Practice Address - Country:US
Practice Address - Phone:207-596-0359
Practice Address - Fax:207-596-0350
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC172081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical