Provider Demographics
NPI:1750776746
Name:CLEMENTI-EADON, KIMBERLY (LMHC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:CLEMENTI-EADON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:CLEMENTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:5 NORTHERN BLVD
Mailing Address - Street 2:SUITE 1607
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-2302
Mailing Address - Country:US
Mailing Address - Phone:603-459-5075
Mailing Address - Fax:
Practice Address - Street 1:5 NORTHERN BLVD
Practice Address - Street 2:SUITE 1607
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-2302
Practice Address - Country:US
Practice Address - Phone:603-459-5075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH837101YM0800X
MA7871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health