Provider Demographics
NPI:1134346059
Name:HESSION, KIMBERLY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:HESSION
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BARRY LN
Mailing Address - Street 2:
Mailing Address - City:BLUE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11715-2101
Mailing Address - Country:US
Mailing Address - Phone:631-868-3009
Mailing Address - Fax:
Practice Address - Street 1:296 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2515
Practice Address - Country:US
Practice Address - Phone:631-472-2629
Practice Address - Fax:631-472-2629
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0694511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY069451-1OtherNY STATE LICENSE NUMBER
NYN2Z931Medicare ID - Type Unspecified