Kimberly Iverne Rodriguez, CRMA

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Practice address

52 Gardiner Street
Patten, ME 04765

Phone

(207) 528-2203

NPI assigned

May 6, 2009

Last updated

May 6, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1241568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241568000000",
    "number": "1386878346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 226",
            "city": "PATTEN",
            "state": "ME",
            "postal_code": "047650226",
            "telephone_number": "207-528-2203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 GARDINER STREET",
            "city": "PATTEN",
            "state": "ME",
            "postal_code": "04765",
            "telephone_number": "207-528-2203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "KIMBERLY",
        "middle_name": "IVERNE",
        "credential": "CRMA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-06",
        "last_updated": "2009-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202450000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danica L Pray, MA
• Cynthia Qualey, RDH
• Lacey E Qualey, R.N.
• Emilie N Raistrick, LCSW
• Randall S Roberts
• Rose M Fuchs (Cornerstone Family Practice)
• Windy M Scott, CNA
• Kellie L Shuck, PMHNP-CNS, BC
• Kimberli Skinner, M.A.
• Amber D Sloat, RN

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Patten, ME
• Providers in Patten, ME by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.