Provider Demographics
NPI:1770329179
Name:FRENCH, KIM MICHELLE
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:MICHELLE
Last Name:FRENCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 VAN SICLEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-5631
Mailing Address - Country:US
Mailing Address - Phone:347-994-7189
Mailing Address - Fax:
Practice Address - Street 1:560 VAN SICLEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-5631
Practice Address - Country:US
Practice Address - Phone:347-994-7189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency