MEDICARE: DR. KIMBERLY V DWYER 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	103T00000X	Psychologist	893	WV
2	103TC0700X	Clinical Psychologist	2530	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992751721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY V DWYER PH.D.

Provider Business Mailing Address
First Line	:	5350 S ROSLYN ST STE 306
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2124
Country	:	US
Telephone Number	:	303-727-0146
Fax Number	:

Provider Business Practice Location Address
First Line	:	5350 S ROSLYN ST STE 306
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2124
Country	:	US
Telephone Number	:	303-727-0146
Fax Number	:

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	02/18/2010

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