Provider Demographics
NPI:1851493415
Name:MANNING, KIMBERLY (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BRIARCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-2530
Mailing Address - Country:US
Mailing Address - Phone:508-435-3350
Mailing Address - Fax:508-497-6325
Practice Address - Street 1:17 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-3211
Practice Address - Country:US
Practice Address - Phone:508-435-3350
Practice Address - Fax:508-497-6325
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALM3820101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1895087Medicaid
MALM1011Medicare UPIN