Provider Demographics
NPI:1487697009
Name:HOUSE, KIMBERLY A (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:HOUSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-0099
Mailing Address - Country:US
Mailing Address - Phone:207-794-6700
Mailing Address - Fax:207-794-6777
Practice Address - Street 1:175 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-0000
Practice Address - Country:US
Practice Address - Phone:207-794-6700
Practice Address - Fax:207-794-6777
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC9962104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME161040200Medicaid
ME161040206Medicaid
ME098304OtherANTHEM LEGACY NUMBER
ME205890199Medicaid
ME161040203Medicaid
ME161040205Medicaid
ME161040204Medicaid
ME201856Medicare Oscar/Certification
MEMM9707Medicare PIN
ME161040203Medicaid
ME201845Medicare Oscar/Certification
ME161040206Medicaid
ME201837Medicare Oscar/Certification
ME201855Medicare Oscar/Certification