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NPI Code Detail

MEDICARE: MS. KIMBERLY M POTTER BCBA LBA LBS

MEDICARE: MS. KIMBERLY M POTTER BCBA LBA LBS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1084116

General Provider Information

NPI Number : 1205127370
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLY M POTTER BCBA LBA LBS
Provider Business Mailing Address
First Line : 1301 SHERMAN AVE
Second Line :
City : PITTSBURGH
State : PA
Zip : 15212-4631
Country : US
Telephone Number : 201-978-3815
Fax Number :
Provider Business Practice Location Address
First Line : 325 N SAINT PAUL ST STE 3100
Second Line :
City : DALLAS
State : TX
Zip : 75201-3923
Country : US
Telephone Number : 888-320-3222
Fax Number : 347-402-2106
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2011
Last Update Date : 06/04/2025

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