Provider Demographics
NPI:1033596945
Name:SOULE, KIMBERLY MARIE (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MARIE
Last Name:SOULE
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:MARIE
Other - Last Name:SLOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1465 POST RD EAST
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880
Mailing Address - Country:US
Mailing Address - Phone:203-955-1871
Mailing Address - Fax:203-955-1874
Practice Address - Street 1:1465 POST RD EAST
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880
Practice Address - Country:US
Practice Address - Phone:203-955-1871
Practice Address - Fax:203-955-1874
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-10423103K00000X
CT002994103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst