Provider Demographics
NPI:1639233117
Name:TAYLOR-ZIMMEL, KRISTIE L (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:L
Last Name:TAYLOR-ZIMMEL
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 1:55 PORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-1230
Mailing Address - Country:US
Mailing Address - Phone:207-318-4603
Mailing Address - Fax:
Practice Address - Street 1:55 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1230
Practice Address - Country:US
Practice Address - Phone:207-318-4603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC114351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical