Provider Demographics
NPI:1508520933
Name:TRIBBETT, KIMBERLY LAVERNE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LAVERNE
Last Name:TRIBBETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-2069
Mailing Address - Country:US
Mailing Address - Phone:856-264-0022
Mailing Address - Fax:
Practice Address - Street 1:132 PERRY ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-3968
Practice Address - Country:US
Practice Address - Phone:609-394-8988
Practice Address - Fax:609-394-0023
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)