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General NPI Number Information
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NPI Number | 1184858078
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Entity Type | Individual
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Provider Name | KIMBERLY SUZANNE NACLERIO LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/07/2009
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Last Update Date | 05/07/2009
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Provider Practice Location Address
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Address Line | 3 SYLVAN RD S
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City | WESTPORT
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State | CT
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Zip | 06880-4639
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Country | US
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Telephone | 203-227-5246
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Fax |
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Provider Business Mailing Address
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Address Line | 270 MARBLEDALE RD
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City | TUCKAHOE
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State | NY
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Zip | 10707-1809
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Country | US
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Telephone | 914-793-6750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 006290
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R056335
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License Number State | NY
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