Doctor Name: | MRS. MELISSA SAMPLES KIMBERLING (NEW NAME) |
NPI Number: | 1013224336 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | RO41152-1 |
Business Practice Address: | 24 Jameson Ct East Northport, NY - 117311629 |
Business Phone Number: | 6317545431 |
Business Fax Number: | |
Mailing Address: | 24 Jameson Ct, EAST NORTHPORT |
State: | NY |
Postal Code: | 117311629 |
Phone Number: | 6317545431 |
Fax Number: | |
NPI Enumeration Date: | 09/08/2010 |
NPI Last Update Date: | 06/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041S0200X |
License Number: | RO41152-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | School |
Taxonomy Definition: |