MEDICARE: DR. KIMBERLY LAWRENCE KOL PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	844	VT
2	103TC0700X	Clinical Psychologist	1272	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669555116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY LAWRENCE KOL PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 351
Second Line	:
City	:	THETFORD CENTER
State	:	VT
Zip	:	05075-0351
Country	:	US
Telephone Number	:	802-356-3506
Fax Number	:

Provider Business Practice Location Address
First Line	:	2945 ROUTE 5
Second Line	:
City	:	EAST THETFORD
State	:	VT
Zip	:	05043
Country	:	US
Telephone Number	:	802-356-3506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	11/23/2015

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