Healthcare Provider Details

I. General information

NPI: 1992434120
Provider Name (Legal Business Name): KIMBERLY ANN ALEXANDER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2022
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E 56TH ST
NEW YORK NY
10022-2661
US

IV. Provider business mailing address

10302 220TH ST
QUEENS VILLAGE NY
11429-2143
US

V. Phone/Fax

Practice location:
  • Phone: 646-625-4290
  • Fax:
Mailing address:
  • Phone: 917-349-8086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number024682
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number024682
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number024682
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number024682
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number024682
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: