Provider Demographics
NPI:1205361623
Name:KYM KIDS PROFESSIONAL SERVICES, INC
Entity Type:Organization
Organization Name:KYM KIDS PROFESSIONAL SERVICES, INC
Other - Org Name:KYM KIDS PROFESSIONAL SERVICES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIAL EDUCATION TEACHER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMARA
Authorized Official - Middle Name:K
Authorized Official - Last Name:YOUNG-MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:570-242-9877
Mailing Address - Street 1:3625 ROCK SPRING LN
Mailing Address - Street 2:
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-8172
Mailing Address - Country:US
Mailing Address - Phone:570-242-9877
Mailing Address - Fax:
Practice Address - Street 1:3625 ROCK SPRING LN
Practice Address - Street 2:
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-8172
Practice Address - Country:US
Practice Address - Phone:570-242-9877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-23
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104415252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMEDICAIDMedicaid