Healthcare Provider Details

I. General information

NPI: 1033596945
Provider Name (Legal Business Name): KIMBERLY MARIE SOULE PH.D., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY MARIE SLOPER PH.D.

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 POST RD EAST
WESTPORT CT
06880
US

IV. Provider business mailing address

1465 POST RD EAST
WESTPORT CT
06880
US

V. Phone/Fax

Practice location:
  • Phone: 203-955-1871
  • Fax: 203-955-1874
Mailing address:
  • Phone: 203-955-1871
  • Fax: 203-955-1874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number002994
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-10423
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: