Provider Demographics
NPI:1851165633
Name:GARGALLO HERNANDEZ, KIMBERLY CARELY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CARELY
Last Name:GARGALLO HERNANDEZ
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 1:164 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1384
Mailing Address - Country:US
Mailing Address - Phone:732-996-8848
Mailing Address - Fax:
Practice Address - Street 1:407 GLENN AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-6109
Practice Address - Country:US
Practice Address - Phone:609-218-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician