Kimberly Jean Bloodsworth
Individual provider Active NPI Behavior Analyst · Berlin, MD
NPI 1720516404 · NPPES record last updated Nov 1, 2017
Key facts
- NPI
- 1720516404
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- LBA358 (MD)
- Practice address
- 10514 Racetrack Rd Ste G
Berlin, MD 21811-3241 - Phone
- (410) 973-2371
- NPI assigned
- May 25, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LBA358 | MD | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ocean Front Counseling | Behavior Analyst | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Behavior Analyst | 103K00000X | LBA358 | MD | Yes |
Addresses
Primary practice location
10514 Racetrack Rd Ste G
Berlin, MD 21811-3241
Mailing address
10514 Racetrack Rd Ste G
Berlin, MD 21811-3241
Phone (410) 973-2301
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 483106300 | Medicaid | MD |
Other providers in Berlin, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.