Provider Demographics
NPI:1750019907
Name:MOORE, KIMBERLY JOY (MS, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOY
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:JOY
Other - Last Name:DWYER-MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, BCBA, LBA
Mailing Address - Street 1:4208 BROOK FARM PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1479
Mailing Address - Country:US
Mailing Address - Phone:502-407-1410
Mailing Address - Fax:
Practice Address - Street 1:4208 BROOK FARM PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1479
Practice Address - Country:US
Practice Address - Phone:502-407-1410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252256103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst