Provider Demographics
NPI:1780017327
Name:CANSINO, KIM MARIA
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIA
Last Name:CANSINO
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 1:27951 SMYTH DR STE 103B
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4049
Mailing Address - Country:US
Mailing Address - Phone:747-258-5004
Mailing Address - Fax:
Practice Address - Street 1:27951 SMYTH DR STE 103B
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4049
Practice Address - Country:US
Practice Address - Phone:747-258-5004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114678101YM0800X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst