Provider Demographics
NPI:1669555116
Name:KOL, KIMBERLY LAWRENCE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:LAWRENCE
Last Name:KOL
Suffix:
Gender:F
Credentials:PSYD
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 351
Mailing Address - Street 2:
Mailing Address - City:THETFORD CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05075-0351
Mailing Address - Country:US
Mailing Address - Phone:802-356-3506
Mailing Address - Fax:
Practice Address - Street 1:2945 ROUTE 5
Practice Address - Street 2:
Practice Address - City:EAST THETFORD
Practice Address - State:VT
Practice Address - Zip Code:05043
Practice Address - Country:US
Practice Address - Phone:802-356-3506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT844103TC0700X
NH1272103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010974Medicaid