Provider Demographics
NPI:1528531084
Name:GIRDLESTONE, KIMBERLY (LCSW)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:GIRDLESTONE
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 1:601 ENGLEWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223
Mailing Address - Country:US
Mailing Address - Phone:716-430-1056
Mailing Address - Fax:
Practice Address - Street 1:3960 HARLEM ROAD
Practice Address - Street 2:SUITE 6B
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-844-9150
Practice Address - Fax:716-839-0145
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0842041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical