MEDICARE: KENNETH KIMBALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		ME

General Provider Information

NPI Number	:	1144179391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH KIMBALL

Provider Business Mailing Address
First Line	:	203 ANDERSON ST STE 1-4
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-7506
Country	:	US
Telephone Number	:	207-298-3496
Fax Number	:	207-358-2586

Provider Business Practice Location Address
First Line	:	203 ANDERSON ST STE 1-4
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-7506
Country	:	US
Telephone Number	:	207-298-3496
Fax Number	:	207-358-2586

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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Directions to “ KENNETH KIMBALL ” Practice Location

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