Provider Demographics
NPI:1376723197
Name:O'CONNELL, KIMBER (MA, BCBA/LABA)
Entity Type:Individual
Prefix:
First Name:KIMBER
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:MA, BCBA/LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 NONSET PATH STE 2
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3441
Mailing Address - Country:US
Mailing Address - Phone:978-460-4575
Mailing Address - Fax:978-560-0051
Practice Address - Street 1:42 NONSET PATH STE 2
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3441
Practice Address - Country:US
Practice Address - Phone:978-460-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0372103K00000X
MA1-11-9472103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst