Provider Demographics
NPI:1306465703
Name:GARRITY, KIMBERLY MAXINE (LICSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MAXINE
Last Name:GARRITY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 WEST RD APT 30
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3752
Mailing Address - Country:US
Mailing Address - Phone:860-574-0936
Mailing Address - Fax:
Practice Address - Street 1:2021 21ST AVE S STE C400
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4350
Practice Address - Country:US
Practice Address - Phone:844-695-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH49771041C0700X
MA2224071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical