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General NPI Number Information
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NPI Number | 1427396100
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Entity Type | Individual
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Provider Name | KIMBERLY CHRISTINE ROSE M.S. BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/30/2013
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 1650 W MAIN ST
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City | LEESBURG
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State | FL
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Zip | 34748-2841
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Country | US
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Telephone | 302-740-1287
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Fax |
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Provider Business Mailing Address
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Address Line | 5116 BALLARK ST
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City | MOUNT DORA
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State | FL
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Zip | 32757-8817
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Country | US
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Telephone | 352-409-1202
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Fax |
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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 | 1-06-3047
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License Number State | FL
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