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General NPI Number Information
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NPI Number | 1255676490
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Entity Type | Individual
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Provider Name | KIMBERLY M BENJAMIN BCBA
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Gender | Female
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 11/21/2018
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Provider Practice Location Address
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Address Line | 10575 SAN LEANDRO ST
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City | VENTURA
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State | CA
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Zip | 93004-2948
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Country | US
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Telephone | 805-918-7085
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Fax | 805-830-1834
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Provider Business Mailing Address
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Address Line | 10575 SAN LEANDRO ST
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City | VENTURA
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State | CA
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Zip | 93004-2948
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Country | US
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Telephone | 805-918-7085
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Fax | 805-830-1834
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-12-11854
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License Number State | CA
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