Provider Demographics
NPI:1265856538
Name:THORNBERRY, KIMBERLY A (MS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:THORNBERRY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-4307
Mailing Address - Country:US
Mailing Address - Phone:513-231-3600
Mailing Address - Fax:513-231-3830
Practice Address - Street 1:943 ROSETREE LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4038
Practice Address - Country:US
Practice Address - Phone:513-231-0780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHMM1021187JJSS812103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool