Provider Demographics
NPI:1194127480
Name:WHITE, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WHITE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BOYLSTON ST UNIT 990281
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02199-1913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:833-271-4232
Practice Address - Street 1:800 BOYLSTON ST UNIT 990281
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02199-1913
Practice Address - Country:US
Practice Address - Phone:617-922-2370
Practice Address - Fax:833-271-4232
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-22-59404103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst