Provider Demographics
NPI:1275278541
Name:KIMBERLY ALI, LLC
Entity Type:Organization
Organization Name:KIMBERLY ALI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:845-248-0124
Mailing Address - Street 1:441 MIDDLETOWN AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-1090
Mailing Address - Country:US
Mailing Address - Phone:845-248-0124
Mailing Address - Fax:
Practice Address - Street 1:3241 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4850
Practice Address - Country:US
Practice Address - Phone:203-951-1687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty