Provider Demographics
NPI:1053602656
Name:DIPIETRO, KIMBERLY R (BA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:DIPIETRO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 16TH ST NW
Mailing Address - Street 2:2A
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3366
Mailing Address - Country:US
Mailing Address - Phone:862-354-3974
Mailing Address - Fax:
Practice Address - Street 1:1813 16TH ST NW
Practice Address - Street 2:2A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-3366
Practice Address - Country:US
Practice Address - Phone:862-354-3974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MDLBA140103K00000X
VA0133000192103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst