Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 7561 | MA |
Y | 103TC0700X | Clinical Psychologist | 7561 | MA |
NPI | 1003887696 |
---|---|
Provider Name | Kimberlie King |
First Address | Newton, MA 02462-1440 |
Second Address | Newton, MA 02462-1440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 10/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P24183 | (02) | |
W06005 | BLUE CROSS BLUE SHIELD (01) | MA |