Healthcare Provider Details

I. General information

NPI: 1245595545
Provider Name (Legal Business Name): KIMBERLY L HUTCHINGS MSW, LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MARKET ST SUITE 106
BOARDMAN OH
44512-2601
US

IV. Provider business mailing address

5500 MARKET ST SUITE 106
BOARDMAN OH
44512-2601
US

V. Phone/Fax

Practice location:
  • Phone: 330-788-1155
  • Fax: 330-788-1467
Mailing address:
  • Phone: 330-788-1155
  • Fax: 330-788-1467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.08000097-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: