Provider Demographics
NPI:1720369697
Name:VANORDEN, KIMBERLY ALLISON (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ALLISON
Last Name:VANORDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 CRITTENDEN BLVD
Mailing Address - Street 2:BOX PSYCH
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-8409
Mailing Address - Country:US
Mailing Address - Phone:585-275-5176
Mailing Address - Fax:585-276-2065
Practice Address - Street 1:300 CRITTENDEN BLVD
Practice Address - Street 2:BOX PSYCH
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-8409
Practice Address - Country:US
Practice Address - Phone:585-275-5176
Practice Address - Fax:585-276-2065
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018820103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical