Healthcare Provider Details

I. General information

NPI: 1508639931
Provider Name (Legal Business Name): KIMBERLY SHIRK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N FRONTAGE RD
MANSFIELD CENTER CT
06250-1648
US

IV. Provider business mailing address

46 EDGEWOOD ST APT 5
STAFFORD SPRINGS CT
06076-1253
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-2261
  • Fax: 860-450-1357
Mailing address:
  • Phone: 860-684-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: