Provider Demographics
NPI:1134379381
Name:PLOURDE, KIMBERLY JO (LCSW)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JO
Last Name:PLOURDE
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 ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:LISBON FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04252-1731
Mailing Address - Country:US
Mailing Address - Phone:207-740-0835
Mailing Address - Fax:207-353-1628
Practice Address - Street 1:12 ADDISON ST
Practice Address - Street 2:
Practice Address - City:LISBON FALLS
Practice Address - State:ME
Practice Address - Zip Code:04252-1731
Practice Address - Country:US
Practice Address - Phone:207-740-0835
Practice Address - Fax:207-353-1628
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC115171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical