Provider Demographics
NPI:1851935530
Name:KIMBLE, ALEXANDER THOMAS (LSW)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:THOMAS
Last Name:KIMBLE
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FIELDCREST DR
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-2221
Mailing Address - Country:US
Mailing Address - Phone:908-723-1087
Mailing Address - Fax:
Practice Address - Street 1:429 N COURTLAND ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-1906
Practice Address - Country:US
Practice Address - Phone:484-225-4323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SL06438600OtherSOCIAL WORK LICENSE NUMBER