Healthcare Provider Details

I. General information

NPI: 1497806889
Provider Name (Legal Business Name): KIMBERLY KNOWLTON-YOUNG LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W PARK ST
LEBANON NH
03766-1378
US

IV. Provider business mailing address

20 W PARK ST OPTIONAL
LEBANON NH
03766
US

V. Phone/Fax

Practice location:
  • Phone: 339-440-1103
  • Fax:
Mailing address:
  • Phone: 339-440-1103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1824
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: