Provider Demographics
NPI:1932119948
Name:ELBIRT, KIMBERLY KIRSTIN (PHD, MA, LMHC, LMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KIRSTIN
Last Name:ELBIRT
Suffix:
Gender:F
Credentials:PHD, MA, LMHC, LMT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:KIRSTIN
Other - Last Name:GABIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2225
Mailing Address - Street 2:4 E CENTRAL ST.
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01613-2225
Mailing Address - Country:US
Mailing Address - Phone:774-701-0620
Mailing Address - Fax:
Practice Address - Street 1:48 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609
Practice Address - Country:US
Practice Address - Phone:774-701-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6079101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional