Provider Demographics
NPI:1851329890
Name:GORMAN, KIMBERLY S (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:S
Last Name:GORMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6640 INTECH BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-2011
Mailing Address - Country:US
Mailing Address - Phone:317-275-6404
Mailing Address - Fax:317-275-7011
Practice Address - Street 1:6640 INTECH BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-2011
Practice Address - Country:US
Practice Address - Phone:317-275-6404
Practice Address - Fax:317-275-7011
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041566A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200316040Medicaid
IN202230Medicare PIN
INM400016483Medicare PIN
IN200316040Medicaid
INM400072824Medicare PIN