Provider Demographics
NPI:1285416305
Name:GAJNOS, KIMBERLY J (CRSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:GAJNOS
Suffix:
Gender:F
Credentials:CRSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 HILL RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03235-1141
Mailing Address - Country:US
Mailing Address - Phone:603-341-8171
Mailing Address - Fax:
Practice Address - Street 1:341 HILL RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NH
Practice Address - Zip Code:03235-1141
Practice Address - Country:US
Practice Address - Phone:603-341-8171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0260101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)