Individual
ALICIA KIMMERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAT
Contact information
Practice address
260 CENTRAL AVE, SILVER CREEK, NY 14136-1222
(716) 450-1594
Mailing address
18 LODI ST, FORESTVILLE, NY 14062-9552
(716) 450-1594
Taxonomy
Speciality
Code
Description
License number
State
221700000X
Art Therapist
Primary
001993
NY
Other
Enumeration date
04/08/2024
Last updated
04/08/2024
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