Healthcare Provider Details

I. General information

NPI: 1417331232
Provider Name (Legal Business Name): KIMBERLY EDWARDS MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4164 CAPTAINS CORRIDOR
GREENBACKVILLE VA
23356-2915
US

IV. Provider business mailing address

4164 CAPTAINS CORRIDOR
GREENBACKVILLE VA
23356-2915
US

V. Phone/Fax

Practice location:
  • Phone: 609-954-0124
  • Fax:
Mailing address:
  • Phone: 609-954-0124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133004623
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number15BC00015800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: