Healthcare Provider Details

I. General information

NPI: 1760743678
Provider Name (Legal Business Name): MRS. KIMARA KIMBEL YOUNG-MURRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HEIDE AVE NW
PALM BAY FL
32907-1052
US

IV. Provider business mailing address

234 ETNA ST
BROOKLYN NY
11208-1418
US

V. Phone/Fax

Practice location:
  • Phone: 570-242-9877
  • Fax:
Mailing address:
  • Phone: 570-242-9877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number104415
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: