Healthcare Provider Details

I. General information

NPI: 1891503793
Provider Name (Legal Business Name): KYMBERLY WASHINGTON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 S STATE ST
LOWVILLE NY
13367-1574
US

IV. Provider business mailing address

482 BLACK RIVER PKWY
WATERTOWN NY
13601-2416
US

V. Phone/Fax

Practice location:
  • Phone: 315-376-5440
  • Fax:
Mailing address:
  • Phone: 315-782-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP133051
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP133051
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: