Provider Demographics
NPI:1821369687
Name:HOWARD, KIMBERLY GENEEN (MED, CAGS, LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:GENEEN
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MED, CAGS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 HAYWARD ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-4421
Mailing Address - Country:US
Mailing Address - Phone:603-289-0919
Mailing Address - Fax:
Practice Address - Street 1:6 MOHAWK DR
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3757
Practice Address - Country:US
Practice Address - Phone:603-289-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH918101YM0800X
NVCP0070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH13937451OtherCAQH PROVIDER IDENTIFICATION