Provider Demographics
NPI:1730521923
Name:SPILLANE, KIMBERLY LYNNE (MS & BCBA)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNNE
Last Name:SPILLANE
Suffix:
Gender:F
Credentials:MS & BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3399 FLUVANNA AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-9782
Mailing Address - Country:US
Mailing Address - Phone:716-664-3069
Mailing Address - Fax:
Practice Address - Street 1:3399 FLUVANNA AVENUE EXT
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-9782
Practice Address - Country:US
Practice Address - Phone:716-664-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst