Provider Demographics
NPI:1346985421
Name:DAVID, KIMBERLY BENEFIELD (LICENSED SCHOOL PSYC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BENEFIELD
Last Name:DAVID
Suffix:
Gender:F
Credentials:LICENSED SCHOOL PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 W INDIANTOWN RD STE 107
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6847
Mailing Address - Country:US
Mailing Address - Phone:561-288-8813
Mailing Address - Fax:
Practice Address - Street 1:920 W INDIANTOWN RD STE 107
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6847
Practice Address - Country:US
Practice Address - Phone:561-288-8813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1408103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool