Provider Demographics
NPI:1841074788
Name:STOUT-KRAMER, KIMBERLY DENISE (SW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DENISE
Last Name:STOUT-KRAMER
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 JEFFERSON AVENUE, SUITE 204
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1630
Mailing Address - Country:US
Mailing Address - Phone:570-344-1186
Mailing Address - Fax:570-344-7641
Practice Address - Street 1:615 JEFFERSON AVENUE, SUITE 204
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1630
Practice Address - Country:US
Practice Address - Phone:570-344-1186
Practice Address - Fax:570-344-7641
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140563104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker