Provider Demographics
NPI:1518630169
Name:KIMBERLY CROCCO INC.
Entity Type:Organization
Organization Name:KIMBERLY CROCCO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CANINO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:631-827-2410
Mailing Address - Street 1:513 PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1701
Mailing Address - Country:US
Mailing Address - Phone:631-827-2410
Mailing Address - Fax:
Practice Address - Street 1:513 PULASKI RD
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-1701
Practice Address - Country:US
Practice Address - Phone:631-827-2410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty