Provider Demographics
NPI:1457385858
Name:HUNTER, KIM A (LCSWR)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:HUNTER
Suffix:
Gender:F
Credentials:LCSWR
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 857
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12484-0857
Mailing Address - Country:US
Mailing Address - Phone:845-687-3424
Mailing Address - Fax:845-687-3493
Practice Address - Street 1:3780 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:NY
Practice Address - Zip Code:12484-5603
Practice Address - Country:US
Practice Address - Phone:845-687-3424
Practice Address - Fax:845-687-3493
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051406R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY352636000OtherMAGELLAN
NY7478419OtherGHI PIN NUMBER
A300001848OtherMEDICARE PTAN
NYN361S1Medicare Oscar/Certification