Basic Information
| Provider Information | |||||||||
| NPI: | 1255694543 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIMBALL | ||||||||
| FirstName: | LORRI | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSW, LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 TWELFTH ST. | ||||||||
| Address2: | RIVERSIDE COURTYARDS | ||||||||
| City: | BERLIN | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037527404 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3 TWELFTH ST | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035703860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037527404 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2012 | ||||||||
| LastUpdateDate: | 06/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1032354 | NH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.