Provider Demographics
NPI:1679109565
Name:KING, KIMBERLEE
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH COLLINS
Mailing Address - State:NY
Mailing Address - Zip Code:14111-2102
Mailing Address - Country:US
Mailing Address - Phone:716-337-3706
Mailing Address - Fax:716-337-2723
Practice Address - Street 1:332 E 4TH ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5502
Practice Address - Country:US
Practice Address - Phone:716-488-1971
Practice Address - Fax:716-483-6878
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No104100000XBehavioral Health & Social Service ProvidersSocial Worker