Provider Demographics
NPI:1194096305
Name:HARRISON, KIMBERLY (MSED, NCSP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MSED, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9110 146TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-4301
Mailing Address - Country:US
Mailing Address - Phone:718-468-9000
Mailing Address - Fax:718-464-2017
Practice Address - Street 1:9110 146TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-4301
Practice Address - Country:US
Practice Address - Phone:718-468-9000
Practice Address - Fax:718-464-2017
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1185551103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool