Healthcare Provider Details

I. General information

NPI: 1538098090
Provider Name (Legal Business Name): KIMBERLY ASENCIO CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 WARD ST
MONTGOMERY NY
12549-1270
US

IV. Provider business mailing address

11 DEERWOOD DR
HOPEWELL JUNCTION NY
12533-6436
US

V. Phone/Fax

Practice location:
  • Phone: 845-293-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number036691
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: