Provider Demographics
NPI:1689793366
Name:JAMES, KIMBERLY MULLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MULLEN
Last Name:JAMES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:242 CAMBON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2504
Mailing Address - Country:US
Mailing Address - Phone:631-584-3403
Mailing Address - Fax:
Practice Address - Street 1:75 LANDING MEADOW RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1124
Practice Address - Country:US
Practice Address - Phone:631-360-4700
Practice Address - Fax:631-360-4790
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014928-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014928-1OtherLICENSE NUMBER
NY014928-1OtherLICENSE NUMBER