Provider Demographics
NPI:1174358733
Name:FLEMING, KIMBERLY (MA; CAS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:FLEMING
Suffix:
Gender:F
Credentials:MA; CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6741 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863-3353
Mailing Address - Country:US
Mailing Address - Phone:410-422-7556
Mailing Address - Fax:
Practice Address - Street 1:6741 SENECA DR
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863-3353
Practice Address - Country:US
Practice Address - Phone:410-422-7556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCER-130797-N1X5F1103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool