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General NPI Number Information
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NPI Number | 1801186374
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Entity Type | Individual
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Provider Name | KIMBERLY SUE IRWIN M.ED., BCABA
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Gender | Female
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Dates
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Enumeration Date | 04/18/2011
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 2533 HICKORY KNOLL LN
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City | RICHMOND
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State | VA
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Zip | 23230-2129
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Country | US
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Telephone | 770-956-8511
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Fax | 770-956-8907
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Provider Business Mailing Address
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Address Line | 41 PACELLA PARK DR
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City | RANDOLPH
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State | MA
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Zip | 02368-1755
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Country | US
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Telephone | 781-440-0400
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Fax | 781-551-9880
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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 |
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License Number State |
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