Provider Demographics
NPI:1205237948
Name:NICHOLS, KIMBERLY JEAN (LCSW-R)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JEAN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:SCAMARONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:1902 ROSEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-5222
Mailing Address - Country:US
Mailing Address - Phone:914-257-3593
Mailing Address - Fax:
Practice Address - Street 1:245 N BROADWAY STE 101
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-2657
Practice Address - Country:US
Practice Address - Phone:914-257-3593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR076662-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical