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NPI Code Detail

MEDICARE: MS. LAURA ELLEN KIMBALL LCSW

MEDICARE: MS. LAURA ELLEN KIMBALL 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
11041C0700XClinical Social WorkerR038243NY

General Provider Information

NPI Number : 1548271000
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LAURA ELLEN KIMBALL LCSW
Provider Business Mailing Address
First Line : 2251 PLUMB FIRST ST.
Second Line : #4-F
City : BROOKLYN
State : NY
Zip : 11229-5750
Country : US
Telephone Number : 718-769-9687
Fax Number :
Provider Business Practice Location Address
First Line : 1623 KINGS HWY
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-1209
Country : US
Telephone Number : 718-954-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2006
Last Update Date : 07/21/2022

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