Provider Demographics
NPI:1619382389
Name:SPANJOL, KIMBERLY (PHD, BCBA-D, LMHC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:SPANJOL
Suffix:
Gender:F
Credentials:PHD, BCBA-D, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 145TH ST
Mailing Address - Street 2:7C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3142
Mailing Address - Country:US
Mailing Address - Phone:917-536-6728
Mailing Address - Fax:
Practice Address - Street 1:300 W 145TH ST
Practice Address - Street 2:7C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-3142
Practice Address - Country:US
Practice Address - Phone:917-536-6728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-21
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health