Provider Demographics
NPI:1083031827
Name:FALLON, KIMBERLY (MA/CAS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:FALLON
Suffix:
Gender:F
Credentials:MA/CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2972 PIKE RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-9550
Mailing Address - Country:US
Mailing Address - Phone:716-474-4268
Mailing Address - Fax:
Practice Address - Street 1:2972 PIKE RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-9550
Practice Address - Country:US
Practice Address - Phone:716-474-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool