Provider Demographics
NPI:1831542075
Name:KIMBALL, JULIA FRIEDMAN (LICSW)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:FRIEDMAN
Last Name:KIMBALL
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 1:160 RIVER ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-3662
Mailing Address - Country:US
Mailing Address - Phone:802-310-7091
Mailing Address - Fax:
Practice Address - Street 1:160 RIVER ST UNIT 103
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3662
Practice Address - Country:US
Practice Address - Phone:802-310-7091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00846501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1027825Medicaid