Provider Demographics
NPI:1164550265
Name:SMITH, KIMBERLY MARIE (MA CCCSLP TSHH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA CCCSLP TSHH
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:MARIE
Other - Last Name:BOBROWSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCCSLP TSHH
Mailing Address - Street 1:80 GRASSLANDS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766
Mailing Address - Country:US
Mailing Address - Phone:631-331-7632
Mailing Address - Fax:631-331-7632
Practice Address - Street 1:80 GRASSLANDS CIRCLE
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766
Practice Address - Country:US
Practice Address - Phone:631-375-3925
Practice Address - Fax:631-267-2950
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0120121235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist