Provider Demographics
NPI:1750078127
Name:LOUGHLIN, KIMBERLY (LMHC, MS)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:LOUGHLIN
Suffix:
Gender:F
Credentials:LMHC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8599 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9779
Mailing Address - Country:US
Mailing Address - Phone:315-345-4431
Mailing Address - Fax:
Practice Address - Street 1:8599 BAYVIEW DR
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9779
Practice Address - Country:US
Practice Address - Phone:315-345-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013381101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health