Provider Demographics
NPI:1962009910
Name:KIMBER, PETA LORRAINE ST CLAIR (BCBA)
Entity Type:Individual
Prefix:
First Name:PETA
Middle Name:LORRAINE ST CLAIR
Last Name:KIMBER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HMS STAYNER DR
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-1664
Mailing Address - Country:US
Mailing Address - Phone:617-957-6451
Mailing Address - Fax:781-385-7324
Practice Address - Street 1:105 HMS STAYNER DR
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1664
Practice Address - Country:US
Practice Address - Phone:617-957-6451
Practice Address - Fax:781-385-7324
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4243103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst