MEDICARE: AGNES KEMIGABO

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
1	103K00000X	Behavior Analyst	15BC00328000	NJ

General Provider Information

NPI Number	:	1407706104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGNES KEMIGABO

Provider Business Mailing Address
First Line	:	2500 RENAISSANCE BLVD STE 170
Second Line	:
City	:	KING OF PRUSSIA
State	:	PA
Zip	:	19406-2639
Country	:	US
Telephone Number	:	484-681-2170
Fax Number	:

Provider Business Practice Location Address
First Line	:	1851 OLD CUTHBERT RD
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-1415
Country	:	US
Telephone Number	:	484-681-2170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/03/2026

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