Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 11114 | ME |
Y | 1041C0700X | Clinical Social Worker | LC12830 | ME |
NPI | 1003012253 |
---|---|
Provider Name | Kimberly Ann Mills |
First Address | South Portland, ME 04106-2316 |
Second Address | Rockland, ME 04841-2739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2007 |
Last Update Date | 08/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003012253 | (05) | ME |