MEDICARE: DR. KIMBERLY DEBRA KALISH PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TA0700X	Adult Development & Aging Psychologist	0163621	NY
2	103TB0200X	Cognitive & Behavioral Psychologist	0163621	NY
3	103TC0700X	Clinical Psychologist	0163621	NY

General Provider Information

NPI Number	:	1821039801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY DEBRA KALISH PH.D.

Provider Business Mailing Address
First Line	:	920 WINTON RD S
Second Line	:	SUITE A
City	:	ROCHESTER
State	:	NY
Zip	:	14618-1634
Country	:	US
Telephone Number	:	585-329-7053
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 WINTON RD S
Second Line	:	SUITE A
City	:	ROCHESTER
State	:	NY
Zip	:	14618-1634
Country	:	US
Telephone Number	:	585-329-7053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	01/17/2015

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