Provider Demographics
NPI:1730419797
Name:BRONSON, KIMBERLY D (LCSW,CCS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:BRONSON
Suffix:
Gender:F
Credentials:LCSW,CCS
Other - Prefix:
Other - First Name:KIMBER
Other - Middle Name:D
Other - Last Name:FREEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 FORE RIVER PKWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2779
Mailing Address - Country:US
Mailing Address - Phone:207-879-3625
Mailing Address - Fax:
Practice Address - Street 1:175 FORE RIVER PKWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2779
Practice Address - Country:US
Practice Address - Phone:207-879-3625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC113801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical