Provider Demographics
NPI:1144687260
Name:KIMBERLY M SPADER PLLC
Entity type:Organization
Organization Name:KIMBERLY M SPADER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPADER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:617-314-5345
Mailing Address - Street 1:2403 WHITE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-6542
Mailing Address - Country:US
Mailing Address - Phone:617-314-5345
Mailing Address - Fax:
Practice Address - Street 1:725 WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7652
Practice Address - Country:US
Practice Address - Phone:910-685-6223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC008069252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency