Provider Demographics
NPI:1639608045
Name:CECCARINI, KIM MARIE
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:CECCARINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:CECCARINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 DELAVAL RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2601
Mailing Address - Country:US
Mailing Address - Phone:774-242-8870
Mailing Address - Fax:
Practice Address - Street 1:11 DELAVAL RD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606
Practice Address - Country:US
Practice Address - Phone:774-242-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator