Provider Demographics
NPI:1720006125
Name:LOVETT, KIMBERLY (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:LOVETT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 LAKE AVE N STE 101
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2073
Mailing Address - Country:US
Mailing Address - Phone:508-753-3220
Mailing Address - Fax:508-753-3224
Practice Address - Street 1:425 LAKE AVE N STE 101
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2073
Practice Address - Country:US
Practice Address - Phone:508-753-3220
Practice Address - Fax:508-753-3224
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223009174400000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A37863Medicare PIN
MAA37863Medicare ID - Type Unspecified