Provider Demographics
NPI:1992751721
Name:DWYER, KIMBERLY V (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:V
Last Name:DWYER
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 1:5350 S ROSLYN ST STE 306
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2124
Mailing Address - Country:US
Mailing Address - Phone:303-727-0146
Mailing Address - Fax:
Practice Address - Street 1:5350 S ROSLYN ST STE 306
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2124
Practice Address - Country:US
Practice Address - Phone:303-727-0146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV893103T00000X
CO2530103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001632Medicaid