Provider Demographics
NPI:1366983918
Name:WEISENBERG, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WEISENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 EMERALD WINDS CIR
Mailing Address - Street 2:8200 EMERALD WINDS CIRCLE
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-7838
Mailing Address - Country:US
Mailing Address - Phone:609-947-5574
Mailing Address - Fax:
Practice Address - Street 1:8200 EMERALD WINDS CIR
Practice Address - Street 2:8200 EMERALD WINDS CIRCLE
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33473-7838
Practice Address - Country:US
Practice Address - Phone:609-947-5574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst