Provider Demographics
NPI:1629445440
Name:HAGE, KIMBERLY (LCSW, SAP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HAGE
Suffix:
Gender:F
Credentials:LCSW, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 N 600 E
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-8363
Mailing Address - Country:US
Mailing Address - Phone:317-437-5104
Mailing Address - Fax:
Practice Address - Street 1:635 N STATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1400
Practice Address - Country:US
Practice Address - Phone:317-437-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007344A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical