Provider Demographics
NPI:1093928608
Name:KIMBER, BRIAN TIMOTHY (MSW)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:TIMOTHY
Last Name:KIMBER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:TIMOTHY
Other - Last Name:KIMBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:3124 SAN RAFAEL AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2348
Mailing Address - Country:US
Mailing Address - Phone:505-265-2343
Mailing Address - Fax:
Practice Address - Street 1:5901 ZUNI RD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3073
Practice Address - Country:US
Practice Address - Phone:505-841-8978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI3674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health