Provider Demographics
NPI:1053758672
Name:TSITSIRIGOS, KIMBERLY T (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:T
Last Name:TSITSIRIGOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 W CENTRAL ST
Mailing Address - Street 2:SUITE 25
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3758
Mailing Address - Country:US
Mailing Address - Phone:508-653-4820
Mailing Address - Fax:508-653-4827
Practice Address - Street 1:251 W CENTRAL ST
Practice Address - Street 2:SUITE 25
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3758
Practice Address - Country:US
Practice Address - Phone:508-653-4820
Practice Address - Fax:508-653-4827
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2189121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical