Individual
KIMBERLY ALEXIS BOULOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NJ LMT #18KT01515000
Contact information
Practice address
18 PARK VIEW AVE PH 2A, JERSEY CITY, NJ 07302-7389
(551) 253-7256
Mailing address
149 ESSEX ST APT 4U, JERSEY CITY, NJ 07302-7514
(551) 253-7256
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
—
—
174H00000X
Health Educator
—
—
225400000X
Rehabilitation Practitioner
—
—
225700000X
Massage Therapist
Primary
—
—
372600000X
Adult Companion
—
—
374J00000X
Doula
—
—
Other
Enumeration date
07/10/2023
Last updated
10/03/2024
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