Healthcare Provider Details

I. General information

NPI: 1801186374
Provider Name (Legal Business Name): KIMBERLY SUE IRWIN M.ED., BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2533 HICKORY KNOLL LN
RICHMOND VA
23230-2129
US

IV. Provider business mailing address

41 PACELLA PARK DR
RANDOLPH MA
02368-1755
US

V. Phone/Fax

Practice location:
  • Phone: 770-956-8511
  • Fax: 770-956-8907
Mailing address:
  • Phone: 781-440-0400
  • Fax: 781-551-9880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: