Provider Demographics
NPI:1760744387
Name:LIGHT BOGDAN, KIMBERLY LLEWELLYN (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LLEWELLYN
Last Name:LIGHT BOGDAN
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ORBIT LN
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6707
Mailing Address - Country:US
Mailing Address - Phone:914-629-0457
Mailing Address - Fax:
Practice Address - Street 1:11 ORBIT LN
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-6707
Practice Address - Country:US
Practice Address - Phone:914-629-0457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist