MEDICARE: KIMBERLY J CHRISTOPHER LCSW

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	1041C0700X	Clinical Social Worker	003155	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215070404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY J CHRISTOPHER LCSW

Provider Business Mailing Address
First Line	:	409 BANTAM RD
Second Line	:	SUITE A1
City	:	LITCHFIELD
State	:	CT
Zip	:	06759-3200
Country	:	US
Telephone Number	:	860-459-6017
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 BANTAM RD
Second Line	:	SUITE A1
City	:	LITCHFIELD
State	:	CT
Zip	:	06759-3200
Country	:	US
Telephone Number	:	860-459-6017
Fax Number	:

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/24/2015

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