Provider Demographics
NPI:1891820601
Name:HALEY, KIMBERLEY JEAN (LMHC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:JEAN
Last Name:HALEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3938
Mailing Address - Country:US
Mailing Address - Phone:978-750-6828
Mailing Address - Fax:978-750-6684
Practice Address - Street 1:65 NEWBURY ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1040
Practice Address - Country:US
Practice Address - Phone:978-750-6828
Practice Address - Fax:978-750-6684
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5854101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health