Provider Demographics
NPI:1386849420
Name:SNOW, KIMBERLEY BEACH (MA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:BEACH
Last Name:SNOW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 SCARLET IRIS PL
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-9412
Mailing Address - Country:US
Mailing Address - Phone:407-672-0046
Mailing Address - Fax:
Practice Address - Street 1:6001 BRICK CT
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9425
Practice Address - Country:US
Practice Address - Phone:407-672-0300
Practice Address - Fax:407-672-0408
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1783101YM0800X
FLMT1309106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist