Provider Demographics
NPI:1639466196
Name:PHILLIPS, KIMBERLY (MS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 EAGLE ST
Mailing Address - Street 2:ADMINISTRATIVE OFFICES
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5376
Mailing Address - Country:US
Mailing Address - Phone:413-236-5656
Mailing Address - Fax:413-499-6572
Practice Address - Street 1:53 EAGLE STREET
Practice Address - Street 2:ADMINISTRATIVE OFFICES
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-629-1262
Practice Address - Fax:413-448-2198
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor