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Individual

KIMBERLY BERRY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMSW-CC

Contact information

Practice address
2 SPRINGBROOK DR, BIDDEFORD, ME 04005-9443
(207) 282-1500
(207) 282-2581
Mailing address
78 ATLANTIC PL, SOUTH PORTLAND, ME 04106-2316
(207) 842-7701
(207) 842-7773

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MC12040
ME
1041C0700X
Clinical Social Worker
MC12040
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
434971299
ME
Enumeration date
11/11/2009
Last updated
11/01/2012
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