Provider Demographics
NPI:1932703378
Name:KIMBERLY JANKUNAS LCSW PLLC
Entity Type:Organization
Organization Name:KIMBERLY JANKUNAS LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JANKUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:330-416-0425
Mailing Address - Street 1:172 OAK LEAF CIR
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-5835
Mailing Address - Country:US
Mailing Address - Phone:330-416-0425
Mailing Address - Fax:315-802-7670
Practice Address - Street 1:172 OAK LEAF CIR
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-5835
Practice Address - Country:US
Practice Address - Phone:330-416-0425
Practice Address - Fax:315-802-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY432450Medicaid