Provider Demographics
NPI:1255676490
Name:BENJAMIN, KIMBERLY M (BCBA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10575 SAN LEANDRO ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-2948
Mailing Address - Country:US
Mailing Address - Phone:805-918-7085
Mailing Address - Fax:805-830-1834
Practice Address - Street 1:10575 SAN LEANDRO ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-2948
Practice Address - Country:US
Practice Address - Phone:805-918-7085
Practice Address - Fax:805-830-1834
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-11854103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst