Provider Demographics
NPI:1801498928
Name:KIMBERLY KNOWLTON-YOUNG, LICSW INC.
Entity type:Organization
Organization Name:KIMBERLY KNOWLTON-YOUNG, LICSW INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOWLTON-YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:339-440-1103
Mailing Address - Street 1:20 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1378
Mailing Address - Country:US
Mailing Address - Phone:339-440-1103
Mailing Address - Fax:
Practice Address - Street 1:20 W PARK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1378
Practice Address - Country:US
Practice Address - Phone:339-440-1103
Practice Address - Fax:866-220-8338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty