Provider Demographics
NPI:1912024555
Name:GAUVREAU, KIMBERLY (MSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GAUVREAU
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 WOODBOURNE RD
Mailing Address - Street 2:A110
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-1510
Mailing Address - Country:US
Mailing Address - Phone:267-587-2399
Mailing Address - Fax:
Practice Address - Street 1:1723 WOODBOURNE RD
Practice Address - Street 2:A110
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1510
Practice Address - Country:US
Practice Address - Phone:267-587-2399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health