Provider Demographics
NPI:1972853521
Name:JAMES, KIMBERLY M (PSYD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:JAMES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 SANDLAKE COMMONS BLVD
Mailing Address - Street 2:SUITE 2229
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8040
Mailing Address - Country:US
Mailing Address - Phone:407-745-5889
Mailing Address - Fax:407-745-5578
Practice Address - Street 1:7350 SANDLAKE COMMONS BLVD
Practice Address - Street 2:SUITE 2229
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8040
Practice Address - Country:US
Practice Address - Phone:407-745-5889
Practice Address - Fax:407-745-5578
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8635103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGR125ZMedicare PIN