Provider Demographics
NPI:1750565511
Name:DEWITT, KIM T (LICSW)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:T
Last Name:DEWITT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WABASSO ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-1051
Mailing Address - Country:US
Mailing Address - Phone:413-281-8794
Mailing Address - Fax:
Practice Address - Street 1:VA COMMUNITY BASED OUTPATIENT CLINIC
Practice Address - Street 2:78 CENTER STREET
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-584-4040
Practice Address - Fax:413-447-8825
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1118971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical