Provider Demographics
NPI:1770308892
Name:STINE, KIMBERLY A (BCBA)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:A
Last Name:STINE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4757
Mailing Address - Country:US
Mailing Address - Phone:203-906-7668
Mailing Address - Fax:
Practice Address - Street 1:2440 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4757
Practice Address - Country:US
Practice Address - Phone:203-906-7668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1721103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst