MEDICARE: MS. KIMBERLY TODD

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	106S00000X	Behavior Technician	699520	NY

General Provider Information

NPI Number	:	1508711763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY TODD

Provider Business Mailing Address
First Line	:	12510 QUEENS BLVD APT 2509
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1513
Country	:	US
Telephone Number	:	516-426-9105
Fax Number	:

Provider Business Practice Location Address
First Line	:	12510 QUEENS BLVD APT 2509
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1513
Country	:	US
Telephone Number	:	516-426-9105
Fax Number	:

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

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

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