Provider Demographics
NPI:1356433734
Name:KIMBALL, RONALD LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEE
Last Name:KIMBALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BURKET CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1355
Mailing Address - Country:US
Mailing Address - Phone:202-452-6257
Mailing Address - Fax:301-608-2624
Practice Address - Street 1:4 BURKET CT
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1355
Practice Address - Country:US
Practice Address - Phone:202-452-6257
Practice Address - Fax:301-608-2624
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY886103T00000X, 103TA0400X, 103TF0200X, 103TP2701X
MD00775103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy