Provider Demographics
NPI:1922483171
Name:SANTA MARIA, KIMBERLI BETH (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLI
Middle Name:BETH
Last Name:SANTA MARIA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KIMBERLI
Other - Middle Name:BETH
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 FAIRWAY DR
Mailing Address - Street 2:#102
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1814
Mailing Address - Country:US
Mailing Address - Phone:888-880-9270
Mailing Address - Fax:954-342-0273
Practice Address - Street 1:8550 UNITED PLAZA BLVD
Practice Address - Street 2:STE 702-N
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2256
Practice Address - Country:US
Practice Address - Phone:888-880-9270
Practice Address - Fax:954-342-0273
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
43-2086187OtherTAX ID#
1861666737OtherNPI #
13596319OtherCAQH#