Provider Demographics
NPI:1770117764
Name:FISK, KIMBERLY (MS, BCBA, LBS, LMT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:FISK
Suffix:
Gender:F
Credentials:MS, BCBA, LBS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MONUMENT RD STE 96
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-5049
Mailing Address - Country:US
Mailing Address - Phone:717-741-8660
Mailing Address - Fax:
Practice Address - Street 1:25 MONUMENT RD STE 96
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5049
Practice Address - Country:US
Practice Address - Phone:717-741-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-20-41153103K00000X
PAMSG014942225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst