Provider Demographics
NPI:1730317793
Name:BARAD, KIMBERLY BENNETT
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BENNETT
Last Name:BARAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3412
Mailing Address - Country:US
Mailing Address - Phone:617-797-1587
Mailing Address - Fax:
Practice Address - Street 1:12 WILDWOOD RD
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3412
Practice Address - Country:US
Practice Address - Phone:617-797-1587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health