Provider Demographics
NPI:1831237387
Name:WALKER, KIMBERLY ALISON (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ALISON
Last Name:WALKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:VT
Mailing Address - Zip Code:05753
Mailing Address - Country:US
Mailing Address - Phone:617-365-3144
Mailing Address - Fax:802-462-3816
Practice Address - Street 1:89 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:VT
Practice Address - Zip Code:05753
Practice Address - Country:US
Practice Address - Phone:617-365-3144
Practice Address - Fax:802-462-3816
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4985101YM0800X
NACBT12574103TB0200X
VT068-0059717103TC1900X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy