Provider Demographics
NPI:1144556556
Name:AUSTIN, KIMBERLY ARIANNE (CAS)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ARIANNE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:ARIANNE
Other - Last Name:STERLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 DORCHESTER AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1423
Mailing Address - Country:US
Mailing Address - Phone:315-529-5685
Mailing Address - Fax:
Practice Address - Street 1:6296 FLY RD
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9333
Practice Address - Country:US
Practice Address - Phone:315-701-5710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1214952103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool