Provider Demographics
NPI:1306905567
Name:WALKER, KIMBERLY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 PARIS HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PARIS
Mailing Address - State:ME
Mailing Address - Zip Code:04281-6325
Mailing Address - Country:US
Mailing Address - Phone:207-318-7703
Mailing Address - Fax:
Practice Address - Street 1:32 N HIGH ST
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1125
Practice Address - Country:US
Practice Address - Phone:207-647-5629
Practice Address - Fax:207-647-5620
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2008-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC109801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical