Provider Demographics
NPI:1053839266
Name:KIM, THERESE MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:MARIE
Last Name:KIM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BARRETT ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-1703
Mailing Address - Country:US
Mailing Address - Phone:413-210-0245
Mailing Address - Fax:413-288-7116
Practice Address - Street 1:125 BARRETT ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-1703
Practice Address - Country:US
Practice Address - Phone:413-210-0245
Practice Address - Fax:413-288-7116
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1249051041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor