Provider Demographics
NPI:1568602597
Name:BECK, KIMBERLY VICTORIA (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:VICTORIA
Last Name:BECK
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 1:3317 W SANTIAGO ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7147
Mailing Address - Country:US
Mailing Address - Phone:813-857-1164
Mailing Address - Fax:
Practice Address - Street 1:3317 W SANTIAGO ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7147
Practice Address - Country:US
Practice Address - Phone:813-857-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1084258103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst