Provider Demographics
NPI:1316002397
Name:HUBBARD, KIMBERLEE MARY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEE
Middle Name:MARY
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 ALBERTA DR STE 2
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1139
Mailing Address - Country:US
Mailing Address - Phone:716-832-0720
Mailing Address - Fax:716-832-5867
Practice Address - Street 1:575 ALBERTA DR STE 2
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1139
Practice Address - Country:US
Practice Address - Phone:716-832-0720
Practice Address - Fax:716-832-5867
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002697103TC0700X
NY0176141103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA395500742DMedicaid