=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821158098
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY E. AMADON LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 07/20/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 FUNDY RD SUITE # 2D
-----------------------------------------------------
City | FALMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04105-1796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-781-2220
-----------------------------------------------------
Fax | 207-781-2242
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 OCEAN ST # 122
-----------------------------------------------------
City | SOUTH PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04106-2849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-233-5307
-----------------------------------------------------
Fax | 207-781-2242
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LC7662
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------