MEDICARE: KIM STANTON LMHC

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	004653	NY

General Provider Information

NPI Number	:	1255761912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM STANTON LMHC

Provider Business Mailing Address
First Line	:	2 MARVILL DR
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12211-1206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 MARVILL DR
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12211-1206
Country	:	US
Telephone Number	:	518-424-6557
Fax Number	:

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

Provider Enumeration Date	:	11/16/2013
Last Update Date	:	11/16/2013

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Directions to “ KIM STANTON LMHC” Practice Location

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