Individual
MR. PETER JEFFERS KIMBALL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
66 STATE ST, PORTLAND, ME 04101-3751
(207) 871-7431
Mailing address
29 TUCKER AVE, PORTLAND, ME 04103-1422
(207) 871-7431
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC10102
ME
Other
Enumeration date
10/01/2010
Last updated
10/01/2010
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