Provider Demographics
NPI:1649223967
Name:KOLTON, KIMBERLEE (LICSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:KOLTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KIMBERLEE
Other - Middle Name:
Other - Last Name:WHALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:519 HARRISON AVE
Mailing Address - Street 2:D612
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4425
Mailing Address - Country:US
Mailing Address - Phone:617-451-0585
Mailing Address - Fax:
Practice Address - Street 1:454 BROADWAY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3034
Practice Address - Country:US
Practice Address - Phone:781-485-8222
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1031671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical