MEDICARE: ANQUINETTE MONIQUE KIMBLE MSW

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	101Y00000X	Counselor		PA

General Provider Information

NPI Number	:	1902294721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANQUINETTE MONIQUE KIMBLE MSW

Provider Business Mailing Address
First Line	:	242 KINGSTON RD
Second Line	:	APT B
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-3907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	242 KINGSTON RD
Second Line	:	APT B
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-3907
Country	:	US
Telephone Number	:	267-253-2976
Fax Number	:

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

Provider Enumeration Date	:	12/31/2014
Last Update Date	:	12/31/2014

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