Provider Demographics
NPI:1649558685
Name:MONTEFUSCO, KIMBERLY BELLA (LPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BELLA
Last Name:MONTEFUSCO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CARRIAGE PL
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2108
Mailing Address - Country:US
Mailing Address - Phone:860-488-0607
Mailing Address - Fax:
Practice Address - Street 1:1 CARRIAGE PL
Practice Address - Street 2:SUITE 4
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2108
Practice Address - Country:US
Practice Address - Phone:860-488-0607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health