Provider Demographics
NPI:1659966430
Name:RASO, KIMBERLY ANNE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:RASO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:CHIDIAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:492 ROUTE 57 W
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-4411
Mailing Address - Country:US
Mailing Address - Phone:908-689-1000
Mailing Address - Fax:908-689-4529
Practice Address - Street 1:108 BILBY RD STE 302
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4174
Practice Address - Country:US
Practice Address - Phone:908-852-0333
Practice Address - Fax:908-852-8732
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06132300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker