Individual
MISS KIMBERLY MARIE LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
215 E 95TH ST, 15F, NEW YORK, NY 10128-4077
(781) 720-8212
Mailing address
215 E 95TH ST, 15F, NEW YORK, NY 10128-4077
(781) 720-8212
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1958934
NY
Other
Enumeration date
03/03/2009
Last updated
03/03/2009
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