Healthcare Provider Details

I. General information

NPI: 1720006125
Provider Name (Legal Business Name): KIMBERLY LOVETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 LAKE AVE N STE 101
WORCESTER MA
01605-2073
US

IV. Provider business mailing address

425 LAKE AVE N STE 101
WORCESTER MA
01605-2073
US

V. Phone/Fax

Practice location:
  • Phone: 508-753-3220
  • Fax: 508-753-3224
Mailing address:
  • Phone: 508-753-3220
  • Fax: 508-753-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number223009
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number223009
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: