Healthcare Provider Details

I. General information

NPI: 1518926682
Provider Name (Legal Business Name): KIMBERLY MCGUIRE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PLEASANT VALLEY WAY
WEST ORANGE NJ
07052-1424
US

IV. Provider business mailing address

1199 PLEASANT VALLEY WAY
WEST ORANGE NJ
07052-1424
US

V. Phone/Fax

Practice location:
  • Phone: 973-731-3600
  • Fax:
Mailing address:
  • Phone: 973-731-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number343885
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number061-A307
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number19650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: