Provider Demographics
NPI:1639937634
Name:KIMBLE, NEAL BAYARD (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:BAYARD
Last Name:KIMBLE
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 JOHNSON MILL RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-6936
Mailing Address - Country:US
Mailing Address - Phone:989-600-1679
Mailing Address - Fax:
Practice Address - Street 1:1161 JOHNSON MILL RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-6936
Practice Address - Country:US
Practice Address - Phone:989-600-1679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP2178103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical