Provider Demographics
NPI:1841470465
Name:DEBOER, KIMBERLY C (PSY D)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:C
Last Name:DEBOER
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BROAD ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1590
Mailing Address - Country:US
Mailing Address - Phone:570-872-9324
Mailing Address - Fax:570-872-9325
Practice Address - Street 1:134 BROAD ST
Practice Address - Street 2:SUITE 5
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1590
Practice Address - Country:US
Practice Address - Phone:570-872-9324
Practice Address - Fax:570-872-9325
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003734101YP2500X
PAPS016801103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
601931565OtherMEDICARE
PA102070114Medicaid
PA102070114Medicaid