Healthcare Provider Details

I. General information

NPI: 1356352017
Provider Name (Legal Business Name): PAUL CIMMINO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 DIVISION ST SUITE 100
BILLINGS MT
59101-6030
US

IV. Provider business mailing address

PO BOX 50928
BILLINGS MT
59105-0900
US

V. Phone/Fax

Practice location:
  • Phone: 406-655-0911
  • Fax: 406-294-0967
Mailing address:
  • Phone: 406-655-0911
  • Fax: 406-294-0967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number223LCSW
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: