Provider Demographics
NPI:1205643244
Name:MCGONIGLE, KIMBERLY (EDS, NCSP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MCGONIGLE
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N POLLARD ST APT 413
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-4089
Mailing Address - Country:US
Mailing Address - Phone:561-891-0258
Mailing Address - Fax:
Practice Address - Street 1:6400 ROCK SPRING DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1913
Practice Address - Country:US
Practice Address - Phone:240-740-6842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCER-189616-Y2X0C2103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool