Provider Demographics
NPI:1922584887
Name:KATES, KIMBERLEY A
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:A
Last Name:KATES
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 1:39 BOYLSTON ST FL 6
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-4702
Mailing Address - Country:US
Mailing Address - Phone:617-457-1008
Mailing Address - Fax:617-542-4705
Practice Address - Street 1:39 BOYLSTON ST FL 6
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4702
Practice Address - Country:US
Practice Address - Phone:617-457-1008
Practice Address - Fax:617-542-4705
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor