Individual
JACQUELYN RENAE KIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
421 N MAIN ST, LEEDS, MA 01053-9764
(413) 584-4040
Mailing address
421 N MAIN ST, LEEDS, MA 01053-9764
(413) 584-4040
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
255263
MA
2084P0800X
Psychiatry Physician
51632
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023060
MBHP
MA
01
—
61082
HEALTH NEW ENGLAND
MA
01
—
J52483
BCBS OF MA
MA
Enumeration date
06/22/2009
Last updated
10/10/2023
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