Provider Demographics
NPI:1265618961
Name:BECKER, KIMBERLY DYAN (PHD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DYAN
Last Name:BECKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N WOLFE STREET/CMSC 346
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0001
Mailing Address - Country:US
Mailing Address - Phone:443-287-4349
Mailing Address - Fax:443-287-4346
Practice Address - Street 1:600 N WOLFE STREET/CMSC 346
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0001
Practice Address - Country:US
Practice Address - Phone:443-287-4349
Practice Address - Fax:443-287-4346
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent