Provider Demographics
NPI:1457543019
Name:KIMBRELL, FAY MAXINE (LCSW)
Entity Type:Individual
Prefix:
First Name:FAY
Middle Name:MAXINE
Last Name:KIMBRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MAXINE
Other - Middle Name:B
Other - Last Name:KIMBRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2319 MAGAZINE ST.
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130
Mailing Address - Country:US
Mailing Address - Phone:504-858-6056
Mailing Address - Fax:504-568-4661
Practice Address - Street 1:2000 CANAL ST.
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-702-4361
Practice Address - Fax:504-568-4661
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2262104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker