Provider Demographics
NPI:1922583806
Name:KIMBERLY MOSSMAN LICSW, LLC
Entity Type:Organization
Organization Name:KIMBERLY MOSSMAN LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, EDS
Authorized Official - Phone:508-273-5008
Mailing Address - Street 1:20 TREMONT ST STE 16
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-5315
Mailing Address - Country:US
Mailing Address - Phone:508-273-5008
Mailing Address - Fax:888-972-9741
Practice Address - Street 1:20 TREMONT ST STE 16
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-5315
Practice Address - Country:US
Practice Address - Phone:508-273-5008
Practice Address - Fax:888-972-9741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty