Provider Demographics
NPI:1548271000
Name:KIMBALL, LAURA ELLEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ELLEN
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELLEN
Other - Last Name:COHEN
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2251 PLUMB FIRST ST.
Mailing Address - Street 2:#4-F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5750
Mailing Address - Country:US
Mailing Address - Phone:718-769-9687
Mailing Address - Fax:
Practice Address - Street 1:1623 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1209
Practice Address - Country:US
Practice Address - Phone:718-954-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0382431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical