Provider Demographics
NPI:1073811469
Name:BRICKMAN, KIMBERLY ANN (BCABA)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:ANN
Last Name:BRICKMAN
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 S ORANGE AVE # 353
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4543
Mailing Address - Country:US
Mailing Address - Phone:703-870-3880
Mailing Address - Fax:775-392-1245
Practice Address - Street 1:2805 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4512
Practice Address - Country:US
Practice Address - Phone:703-870-3880
Practice Address - Fax:775-392-1245
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000170106E00000X
VA0-16-7534106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst