Provider Demographics
NPI:1124668959
Name:WENERD, KIMBERLY LAUREN (BCBA)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LAUREN
Last Name:WENERD
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 1:1601 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2707
Mailing Address - Country:US
Mailing Address - Phone:717-448-5506
Mailing Address - Fax:
Practice Address - Street 1:210 BELLEFONTE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-2502
Practice Address - Country:US
Practice Address - Phone:302-762-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1-19-39330103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst