Provider Demographics
NPI:1902812357
Name:KIMMEL, DONNA TOBY (PHD,)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:TOBY
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:PHD,
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:TOBY
Other - Last Name:KIMMEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:10114 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4034
Mailing Address - Country:US
Mailing Address - Phone:240-277-4427
Mailing Address - Fax:301-530-1250
Practice Address - Street 1:10114 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4034
Practice Address - Country:US
Practice Address - Phone:240-277-4427
Practice Address - Fax:301-530-1250
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2009101YP2500X, 101YM0800X
DC1926103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC436193Medicare PIN
DC014434H93Medicare PIN