Provider Demographics
NPI:1689728396
Name:KIMBALL, MARGARET REVELLE
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:REVELLE
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:REVELLE
Other - Last Name:KIMBALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:32 LINWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-1132
Mailing Address - Country:US
Mailing Address - Phone:207-522-1704
Mailing Address - Fax:
Practice Address - Street 1:32 LINWOOD RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-1132
Practice Address - Country:US
Practice Address - Phone:207-522-1704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4122101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM6891Medicare ID - Type Unspecified