Basic Information
| Provider Information | |||||||||
| NPI: | 1962660571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GENDRON | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 84 HIGH ST | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | MEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021553844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786975733 | ||||||||
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| Practice Location | |||||||||
| Address1: | 84 HIGH ST | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | MEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021553844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034341577 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2008 | ||||||||
| LastUpdateDate: | 02/24/2015 | ||||||||
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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 | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.