Provider Demographics
NPI:1891005799
Name:MCLAIN, KIMBERLY BRADFORD (PHD, LMHC, NCC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:BRADFORD
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:PHD, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-1929
Mailing Address - Country:US
Mailing Address - Phone:607-725-9694
Mailing Address - Fax:
Practice Address - Street 1:10 TAFT AVE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-1929
Practice Address - Country:US
Practice Address - Phone:607-725-9694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003593101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health