Kristin Lynn Dimberg, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

086836 Issued in NY

Practice address

401 W. Main St.
Montour Falls, NY 14865

Phone

(802) 488-6934

Fax

(802) 488-6919

NPI assigned

May 11, 2016

Last updated

Jun 3, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Elevate Wellness Psychotherapy LCSW PLLC

  • Clinical Social Worker
  • Kingston, NY
  • NPI 1922931088
  NPD Authorized official

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

{
    "created_epoch": "1462924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622678400000",
    "number": "1437505294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 650",
            "city": "MONTOUR FALLS",
            "state": "NY",
            "postal_code": "14865",
            "telephone_number": "860-391-3677",
            "fax_number": "802-488-6919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W. MAIN ST.",
            "city": "MONTOUR FALLS",
            "state": "NY",
            "postal_code": "14865",
            "telephone_number": "802-488-6934",
            "fax_number": "802-488-6919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIMBERG",
        "first_name": "KRISTIN",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-11",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VT",
            "license": "089-0109854",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "086836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abagail Margaret Close, M.S.
• James P Coleman, MD
• Susan K Conklin, RPH
• Michelle Lynn Creary, OT
• Kristina M Cummings, D.O.
• Susann Louise Dugo
• Karen M Dumont, RPAC
• Michael Herbert Eisman, M.D.
• Deidra Onalee Ettenberger, PTA
• Falls Home Inc

• Clinical Social Worker in Montour Falls, NY
• Providers in Montour Falls, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2021; 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.