Peter Jeffers Kimball Jr., LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC10102 Issued in ME

Practice address

66 State St
Portland, ME 04101-3751

Phone

(207) 871-7431

NPI assigned

Oct 1, 2010

Last updated

Oct 1, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Catholic Charities Maine

  • Clinical Social Worker
  • Portland, ME
  • NPI 1013955947
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285891200000",
    "number": "1023327400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 TUCKER AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041031422",
            "telephone_number": "207-871-7431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 STATE ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041013751",
            "telephone_number": "207-871-7431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "PETER",
        "middle_name": "JEFFERS",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-01",
        "last_updated": "2010-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC10102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eugene Kim, DDS
• Marina Kim, D.O.
• Paul S. Kim, M.D.
• Yun Ae Kim, D.M.D
• Katie Kimball, LCPC-C
• Katherine Neal Kimmelshue, MD
• Nicole Suzette Kimmes, DDS
• Abby King, PA-C
• Diane Sanford King, CST AS-C
• Robert Charles King, MD

• Clinical Social Worker in Portland, ME
• Providers in Portland, ME by specialty
• Clinical Social Worker in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.