Doctor Name: | KIMBERLY ANN STRUCK |
NPI Number: | 1578604997 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | LC8214 |
Business Practice Address: | 14 Wyonegonic Rd Bridgton, ME - 040094652 |
Business Phone Number: | 2076479021 |
Business Fax Number: | 2076475932 |
Mailing Address: | 14 Wyonegonic Rd, BRIDGTON |
State: | ME |
Postal Code: | 040094652 |
Phone Number: | 2076479021 |
Fax Number: | 2076475932 |
NPI Enumeration Date: | 02/09/2007 |
NPI Last Update Date: | 02/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LC8214 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |