Provider Demographics
NPI:1730275330
Name:PIERS, KIMBERLY JEAN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JEAN
Last Name:PIERS
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 1:17 93RD ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3748
Mailing Address - Country:US
Mailing Address - Phone:603-399-0025
Mailing Address - Fax:
Practice Address - Street 1:64 MAIN ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3701
Practice Address - Country:US
Practice Address - Phone:603-283-0678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH987104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81263595Medicaid
NH104100000XOtherTAXONOMY CODE
NH81263595Medicaid