Provider Demographics
NPI:1982758249
Name:CARRASQUILLO, KIMBERLY ANNE (MSW/MBA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:MSW/MBA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:BURNELL-CARRASQUILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1233 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040
Mailing Address - Country:US
Mailing Address - Phone:413-539-2480
Mailing Address - Fax:413-539-2496
Practice Address - Street 1:1233 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-539-2480
Practice Address - Fax:413-539-2496
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical