Provider Demographics
NPI:1578124384
Name:BARLOW, KYMBERLEY KAY
Entity Type:Individual
Prefix:
First Name:KYMBERLEY
Middle Name:KAY
Last Name:BARLOW
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 1:6626 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-2356
Mailing Address - Country:US
Mailing Address - Phone:209-495-9306
Mailing Address - Fax:
Practice Address - Street 1:5501 ANTIQUE ROSE WAY
Practice Address - Street 2:
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-9505
Practice Address - Country:US
Practice Address - Phone:209-521-4791
Practice Address - Fax:209-521-4791
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-23
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst