Healthcare Provider Details

I. General information

NPI: 1912376286
Provider Name (Legal Business Name): KIMBERLY BORICK MA,BCBA,LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20402 N 15TH AVE
PHOENIX AZ
85027-3636
US

IV. Provider business mailing address

20402 N 15TH AVE
PHOENIX AZ
85027-3636
US

V. Phone/Fax

Practice location:
  • Phone: 518-321-9438
  • Fax:
Mailing address:
  • Phone: 518-321-9438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133000645
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: