Provider Demographics
NPI:1063599561
Name:KIMPSON, VENEE KIM (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:VENEE
Middle Name:KIM
Last Name:KIMPSON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1901 MADISON AVE
Mailing Address - Street 2:#223
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2700
Mailing Address - Country:US
Mailing Address - Phone:917-573-7847
Mailing Address - Fax:888-217-8515
Practice Address - Street 1:57 W 57TH ST
Practice Address - Street 2:SUITE 1210
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2802
Practice Address - Country:US
Practice Address - Phone:917-573-7847
Practice Address - Fax:888-217-8515
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0781781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY078178OtherLICENSED CLINICAL SOCIAL WORK