Provider Demographics
NPI:1700967577
Name:KIDWELL, JAMES WILLLIAM (MSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLLIAM
Last Name:KIDWELL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:34 GREENLIEF ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5325
Mailing Address - Country:US
Mailing Address - Phone:207-622-4895
Mailing Address - Fax:207-622-4895
Practice Address - Street 1:1 VA CENTER 122B
Practice Address - Street 2:VA HOSPITAL
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-623-5719
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC59161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical