Provider Demographics
NPI:1114581725
Name:NEAL, KIMBERLY A
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DIANE CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08827-4533
Mailing Address - Country:US
Mailing Address - Phone:908-892-3437
Mailing Address - Fax:
Practice Address - Street 1:1 DIANE CT
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08827-4533
Practice Address - Country:US
Practice Address - Phone:908-892-3437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ12345678Medicaid