Healthcare Provider Details

I. General information

NPI: 1669197745
Provider Name (Legal Business Name): KIMBERLY MAGUIRE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 NORTH ST
HARRISON NY
10528-1140
US

IV. Provider business mailing address

201 WILLETT AVE APT 230
PORT CHESTER NY
10573-4286
US

V. Phone/Fax

Practice location:
  • Phone: 914-925-5089
  • Fax:
Mailing address:
  • Phone: 914-391-6391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103193
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: