Provider Demographics
NPI:1811017452
Name:PANARO, KIM MARIE (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:MARIE
Last Name:PANARO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HOMESTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-1906
Mailing Address - Country:US
Mailing Address - Phone:518-482-4359
Mailing Address - Fax:518-436-3576
Practice Address - Street 1:116 S LAKE AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3371
Practice Address - Country:US
Practice Address - Phone:518-465-8728
Practice Address - Fax:518-436-3576
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR037502-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical