Provider Demographics
NPI:1356352017
Name:CIMMINO, PAUL (LCSW)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:CIMMINO
Suffix:
Gender:M
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:PO BOX 50928
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-0900
Mailing Address - Country:US
Mailing Address - Phone:406-655-0911
Mailing Address - Fax:406-294-0967
Practice Address - Street 1:1004 DIVISION ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-6030
Practice Address - Country:US
Practice Address - Phone:406-655-0911
Practice Address - Fax:406-294-0967
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT223LCSW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000071130OtherBCBS
MT05022639Medicaid
MT05022639Medicaid