Provider Demographics
NPI:1003879537
Name:KIRKPATRICK JUSTICE, KIMBERLY ANN (PHD, ABPP)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:KIRKPATRICK JUSTICE
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 LAKE BALDWIN LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814
Mailing Address - Country:US
Mailing Address - Phone:407-463-4044
Mailing Address - Fax:
Practice Address - Street 1:1483 LAKE BALDWIN LN
Practice Address - Street 2:SUITE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814
Practice Address - Country:US
Practice Address - Phone:321-422-0145
Practice Address - Fax:949-266-1670
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7064103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist