Provider Demographics
NPI:1992504559
Name:KIMMONS, REBECCA (LMSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KIMMONS
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-3220
Mailing Address - Country:US
Mailing Address - Phone:410-219-9000
Mailing Address - Fax:
Practice Address - Street 1:120 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6465
Practice Address - Country:US
Practice Address - Phone:410-210-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD32133104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker