Provider Demographics
NPI:1538463286
Name:GOODWIN, KIMBERLY STONE (MA, BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:STONE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MA, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 BOSTON TPKE
Mailing Address - Street 2:REECE CENTER THERAPY, LLC
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3869
Mailing Address - Country:US
Mailing Address - Phone:508-925-0083
Mailing Address - Fax:508-848-0925
Practice Address - Street 1:364 BOSTON TPKE
Practice Address - Street 2:REECE CENTER THERAPY, LLC
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3869
Practice Address - Country:US
Practice Address - Phone:508-925-0083
Practice Address - Fax:508-848-0925
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA282103K00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health