Provider Demographics
NPI:1871870675
Name:KRAUS, KIMBALL T (MS, LMFT)
Entity type:Individual
Prefix:
First Name:KIMBALL
Middle Name:T
Last Name:KRAUS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 E. GENESEE ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152
Mailing Address - Country:US
Mailing Address - Phone:315-420-4333
Mailing Address - Fax:
Practice Address - Street 1:3109 W LAKE RD
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-9606
Practice Address - Country:US
Practice Address - Phone:315-420-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06000868106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist