Provider Demographics
NPI:1659882314
Name:CHRONISTER, KIMBERLEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEE
Middle Name:
Last Name:CHRONISTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 ELM AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2116
Mailing Address - Country:US
Mailing Address - Phone:310-343-8790
Mailing Address - Fax:
Practice Address - Street 1:2001 S BARRINGTON AVE STE 312
Practice Address - Street 2:
Practice Address - City:WEST LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5379
Practice Address - Country:US
Practice Address - Phone:310-343-8790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28059103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical