Provider Demographics
NPI:1417331232
Name:EDWARDS, KIMBERLY (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 EDWARDS PL
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-2009
Mailing Address - Country:US
Mailing Address - Phone:609-954-0124
Mailing Address - Fax:
Practice Address - Street 1:8 EDWARDS PL
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-2009
Practice Address - Country:US
Practice Address - Phone:609-954-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-14-9915103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst