Provider Demographics
NPI:1306367909
Name:HIRSCH, KIMBER (MSPED, AUTISM)
Entity Type:Individual
Prefix:
First Name:KIMBER
Middle Name:
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:MSPED, AUTISM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5386 SANTA TERESITA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9204
Mailing Address - Country:US
Mailing Address - Phone:915-731-2785
Mailing Address - Fax:
Practice Address - Street 1:5386 SANTA TERESITA DR
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9204
Practice Address - Country:US
Practice Address - Phone:915-731-2785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician