Provider Demographics
NPI:1003315300
Name:KIMPLE, KATY ANNE RENDINARO (LMSW)
Entity type:Individual
Prefix:
First Name:KATY ANNE
Middle Name:RENDINARO
Last Name:KIMPLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BANK ST
Mailing Address - Street 2:
Mailing Address - City:NEWFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14867-9311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39 BANK ST
Practice Address - Street 2:
Practice Address - City:NEWFIELD
Practice Address - State:NY
Practice Address - Zip Code:14867-9311
Practice Address - Country:US
Practice Address - Phone:518-420-5169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health