Provider Demographics
NPI:1871516831
Name:BROWN-LUPIA, KIMBERLY A (PHD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:BROWN-LUPIA
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2080 FAIRPORT NINE MILE POINT RD
Mailing Address - Street 2:PO BOX 7
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526
Mailing Address - Country:US
Mailing Address - Phone:585-775-9075
Mailing Address - Fax:
Practice Address - Street 1:2080 FAIRPORT NINE MILE POINT RD
Practice Address - Street 2:PO BOX 7
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526
Practice Address - Country:US
Practice Address - Phone:585-775-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019158103TC2200X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent