Healthcare Provider Details

I. General information

NPI: 1851588917
Provider Name (Legal Business Name): KIMBERLY D COWBURN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 07/18/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 EAST AVE
ANDOVER NY
14806-9316
US

IV. Provider business mailing address

11 EAST AVE
ANDOVER NY
14806-9316
US

V. Phone/Fax

Practice location:
  • Phone: 607-857-1246
  • Fax:
Mailing address:
  • Phone: 607-857-1245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number080998
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: