Provider Demographics
NPI:1609233568
Name:JEWERS-DAILLEY, KIMBERLY (MA, RDT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:JEWERS-DAILLEY
Suffix:
Gender:F
Credentials:MA, RDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SCIENCE PARK
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1966
Mailing Address - Country:US
Mailing Address - Phone:203-777-8648
Mailing Address - Fax:
Practice Address - Street 1:5 SCIENCE PARK
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1966
Practice Address - Country:US
Practice Address - Phone:203-777-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-24
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor