Provider Demographics
NPI:1063762904
Name:WANNEMACHER, KIMBERLY RUTH (BCBA)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RUTH
Last Name:WANNEMACHER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 CRAIG RD
Mailing Address - Street 2:CARING FAMILY COMMUNITY SERVICES
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8735
Mailing Address - Country:US
Mailing Address - Phone:732-780-2799
Mailing Address - Fax:732-780-2899
Practice Address - Street 1:200 CRAIG RD
Practice Address - Street 2:CARING FAMILY COMMUNITY SERVICES
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8735
Practice Address - Country:US
Practice Address - Phone:732-780-2799
Practice Address - Fax:732-780-2899
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-12-11502103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst