Provider Demographics
NPI:1396198024
Name:PELFREY, KIM ANN
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ANN
Last Name:PELFREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 COUNTY ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:10958-4509
Mailing Address - Country:US
Mailing Address - Phone:845-551-7321
Mailing Address - Fax:
Practice Address - Street 1:807 COUNTY ROUTE 12
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:10958-4509
Practice Address - Country:US
Practice Address - Phone:845-551-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst