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General NPI Number Information
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NPI Number | 1962863050
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Entity Type | Individual
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Provider Name | KIMBERLY BURGUM LUCHINI LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 37 PARK ST STE 302
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City | LEWISTON
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State | ME
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Zip | 04240-7195
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Country | US
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Telephone | 207-613-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 4 ENTERPRISE DR
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City | BRUNSWICK
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State | ME
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Zip | 04011-2711
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Country | US
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Telephone | 207-939-3191
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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 | LC17273
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License Number State | ME
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