Provider Demographics
NPI:1093146300
Name:KISH, KIMBERLY (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:KISH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4252 ALBANY POST RD STE 2
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1766
Mailing Address - Country:US
Mailing Address - Phone:845-233-5935
Mailing Address - Fax:845-233-4726
Practice Address - Street 1:4252 ALBANY POST RD STE 2
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1766
Practice Address - Country:US
Practice Address - Phone:845-233-5935
Practice Address - Fax:845-233-4726
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006244101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006244OtherLICENSED MENTAL HEALTH COUNSELOR