Provider Demographics
NPI:1750856738
Name:SHIGO, KIMBERLY (RBT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SHIGO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2858
Mailing Address - Country:US
Mailing Address - Phone:609-481-2795
Mailing Address - Fax:
Practice Address - Street 1:1252 11TH ST
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2858
Practice Address - Country:US
Practice Address - Phone:609-481-2795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-18-66243106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician