Individual provider Active NPI

Kimberley C Desir, PSYD

  • Clinical Psychologist
  • Philadelphia, PA
National Provider Identifier
1023743044
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS020250 Issued in PA
Practice address
525 S 4TH St Ste 471
Philadelphia, PA 19147-1582
Phone
(267) 861-3685
NPI assigned
Jul 22, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PA
Clinical Psychologist 103TC0700X PS020250 PA Primary

Addresses

Primary practice location

525 S 4TH St Ste 471
Philadelphia, PA 19147-1582

Mailing address

525 S 4TH St Ste 471
Philadelphia, PA 19147-1582

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PS020250PAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Equilibria Psychological and Consultation Services, LLC Clinical CurrentSince Jul 24, 2022 Accepting new patients
Equilibria Mental Health of New Jersey LLC Clinical PastSince Mar 24, 2025 Accepting new patients

Locations

525 S 4th St
Ste 471
Philadelphia, PA 19147
Phone (215) 861-3685

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1023743044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 S 4TH ST STE 471",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191471582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 S 4TH ST STE 471",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191471582",
            "telephone_number": "267-861-3685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESIR",
        "first_name": "KIMBERLEY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-22",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS020250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.