Provider Demographics
NPI:1780124354
Name:CRANDALL, KIMBERLY DALE (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DALE
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-2836
Mailing Address - Country:US
Mailing Address - Phone:203-723-7777
Mailing Address - Fax:203-792-4444
Practice Address - Street 1:305 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-2836
Practice Address - Country:US
Practice Address - Phone:203-723-7777
Practice Address - Fax:203-792-4444
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0096801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical