DR. KIMBERLY SUE WALITZER (NPI# 1275003659) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275003659 |
| Entity Type | Individual |
| Full Name | DR. KIMBERLY SUE WALITZER |
| Credential | PHD |
| Practice Address |
300 West Ave Brockport NY 14420-1118 |
| Practice Telephone | 5856373905 |
| Practice Fax Number | 5856372375 |
| Mailing Telephone | 5856373905 |
| Mailing Fax Number | 5856374990 |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2018-11-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TA0400X |
Psychologist Specialization: Addiction (Substance Use Disorder) |
011162 | NY | Behavioral Health & Social Service Providers |
| Street Address |
300 WEST AVE |
| City | BROCKPORT |
| State | NY |
| Zip Code | 14420-1118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790749471 | Robert William Ford | Optometrist | 300 West Ave, Oak Orchard Community Health Center, Brockport, NY 14420 | 2006-04-12 |
| 1720599533 | Erin Elisabeth Goodrich | Dietitian, Registered | 300 West Ave, Brockport, NY 14420-1118 | 2017-10-19 |
| 1790224335 | Valerie Mostyn | Social Worker | 300 West Ave, Brockport, NY 14420-1118 | 2017-02-15 |
| 1316485378 | Christina Smith | Dental Hygienist | 300 West Ave, Brockport, NY 14420-1118 | 2017-02-09 |
| 1447606215 | Chanh Huynh | Family Medicine | 300 West Ave, Brockport, NY 14420 | 2016-05-10 |
| 1851755664 | Tammy L Cornelius | Dental Hygienist | 300 West Ave, Brockport, NY 14420-1118 | 2016-04-07 |
| 1962890608 | Katherine Ann Trawick | Dentist | 300 West Ave, Brockport, NY 14420-1118 | 2015-01-05 |
| 1336537562 | Catherine Goetz | Physician Assistant | 300 West Ave, Brockport, NY 14420-1118 | 2014-12-22 |
| 1538592258 | Kelsey Eleanor Miller | Pediatrics | 300 West Ave, Brockport, NY 14420-1118 | 2013-08-16 |
| 1821341314 | Linda Ranalletti | Dental Hygienist | 300 West Ave, Brockport, NY 14420-1118 | 2012-10-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194217471 | Brianna Lynn Bunch | Licensed Practical Nurse | 126 White Road, Brockport, NY 14420 | 2018-06-03 |
| 1174012785 | Penny Bowers | Massage Therapist | 27 Market Street, Upstairs, Brockport, NY 14420 | 2018-05-09 |
| 1386172062 | Allison Manly | Dentist | 1000 Transit Way, Brockport, NY 14420 | 2017-05-25 |
| 1235518143 | Erin B Chapman | Physical Medicine & Rehabilitation | 350 New Campus Drive, Brockport, NY 14420 | 2015-05-26 |
| 1972853653 | Theresa Fox Lehman | Specialist | 32 Mission Hill Drive, Brockport, NY 14420 | 2012-09-11 |
| 1689946303 | Beverly Whiteman | Registered Nurse | 40 Allen St., Brockport, NY 14420 | 2012-01-27 |
| 1316217425 | Julie Ann Knapp | Registered Nurse | 40 Allen Street, Brockport Central School District, Brockport, NY 14420 | 2012-01-05 |
| 1851678965 | Jennifer Anne Cohen | Registered Nurse | 188 Utica Street, Brockport, NY 14420 | 2011-11-03 |
| 1205088960 | Amy Maureen Hennessy | Obstetrics & Gynecology | 6668 Fourth Section Rd Ste 500, Brockport, NY 14420 | 2008-10-14 |
| 1053454884 | Nancy S Iafrati | Nurse Practitioner | Suny Brockport Student Health Center, 350 New Campus Drive, Brockport, NY 14420 | 2007-02-14 |
| Find all providers in zip 14420 | ||||
| Taxonomy Code | 103TA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154959963 | Timothy James Wisniewski | Psychologist | 845 Central Ave Ste 1, Albany, NY 12206-1514 | 2020-03-28 |
| 1689193955 | Svetlana Levak | Psychologist | 1010 Northern Blvd Ste 311, Great Neck, NY 11021-5329 | 2017-09-18 |
| 1447776323 | Suzanne Alexandra Black | Psychologist | 345 Riverside Dr Apt 2f, New York, NY 10025-3452 | 2017-08-22 |
| 1215300272 | Cosette Annette Hampton | Psychologist | 530 West 187 Street, Just One Break Inc, New York City, NY 10033-1437 | 2015-11-12 |
| 1417327016 | Medicasafe, Inc. | Psychologist | 131 Varick St, Suite 934, New York, NY 10013-1410 | 2015-09-25 |
| 1487045084 | 2000 Medical Associates LLC | Psychologist | 2000 Maple Hill St # Stte101, Yorktown Heights, NY 10598-4176 | 2015-02-18 |
| 1184040123 | Integrative Neuropsych Center | Psychologist | 65 Broadway Ste 812, New York, NY 10006-2503 | 2014-03-14 |
| 1346512936 | Daniel Amado Trujillo | Psychologist | 50 Haven Ave, 102, New York, NY 10032-2652 | 2012-01-30 |
| 1831489186 | Daniel Selling | Psychologist | 1606 Hazen St, East Elmhurst, NY 11370-1331 | 2011-04-07 |
| 1700035706 | Katy G Walsh | Psychologist | 6384 Mill St, Suite 2, Rhinebeck, NY 12572-1404 | 2008-09-15 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on DR. KIMBERLY SUE WALITZER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.