Provider Demographics
NPI:1871644336
Name:BURDEN, KIMBERLEY ANNE (LCMHC, LCAT)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ANNE
Last Name:BURDEN
Suffix:
Gender:F
Credentials:LCMHC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:NH
Mailing Address - Zip Code:03456-1004
Mailing Address - Country:US
Mailing Address - Phone:603-446-7330
Mailing Address - Fax:
Practice Address - Street 1:7 MAIN ST
Practice Address - Street 2:SUITE 5A
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3711
Practice Address - Country:US
Practice Address - Phone:603-357-1375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH611101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013040Medicaid
NH30424344Medicaid