Healthcare Provider Details

I. General information

NPI: 1326297763
Provider Name (Legal Business Name): KIMBERLY ANNE CAMPBELL MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY ANNE LABERGE LICSW

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 TSIENNETO RD
DERRY NH
03038
US

IV. Provider business mailing address

10 TSIENNETO RD
DERRY NH
03038
US

V. Phone/Fax

Practice location:
  • Phone: 603-434-1577
  • Fax: 603-226-7508
Mailing address:
  • Phone: 603-434-1577
  • Fax: 603-226-7508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC11117
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1563
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC11117
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: