1386135408 NPI number — KIMBERLY SLOMAN BCBA-D

Table of content: KIMBERLY SLOMAN BCBA-D (NPI 1386135408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386135408 NPI number — KIMBERLY SLOMAN BCBA-D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLOMAN
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCBA-D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386135408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 W. UNIVERSITY BLVD.
Provider Second Line Business Mailing Address:
THE SCOTT CENTER
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-674-8106
Provider Business Mailing Address Fax Number:
321-674-8411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 W. UNIVERSITY BLVD.
Provider Second Line Business Practice Location Address:
THE SCOTT CENTER
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-674-8106
Provider Business Practice Location Address Fax Number:
321-674-8411
Provider Enumeration Date:
05/24/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-05-2553 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1-05-2553 . This is a "BCBA-D CERTIFICATION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 100249400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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