Provider Demographics
NPI:1013464965
Name:SNOW, KIMBERLY HOPE (LICSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:HOPE
Last Name:SNOW
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 SAXONY DR
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2143
Mailing Address - Country:US
Mailing Address - Phone:978-518-0825
Mailing Address - Fax:
Practice Address - Street 1:43 SAXONY DR
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-2143
Practice Address - Country:US
Practice Address - Phone:978-518-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10198111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical