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NPI Code Detail

MEDICARE: MS. KIM E. PEARSON MSW, LICSW

MEDICARE:  MS. KIM E. PEARSON  MSW, LICSW
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
11041C0700XClinical Social Worker111761MA

General Provider Information

NPI Number : 1972698017
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIM E. PEARSON MSW, LICSW
Provider Business Mailing Address
First Line : 2425 HIGHLAND AVE
Second Line :
City : FALL RIVER
State : MA
Zip : 02720-4508
Country : US
Telephone Number : 508-679-8511
Fax Number : 508-678-7640
Provider Business Practice Location Address
First Line : 2425 HIGHLAND AVE
Second Line :
City : FALL RIVER
State : MA
Zip : 02720-4508
Country : US
Telephone Number : 508-679-8511
Fax Number : 508-678-7640
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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