Provider Demographics
NPI:1568809051
Name:GUILLEM, KIMBERLY (MSED)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:GUILLEM
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:ALOISI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:229 LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1100
Mailing Address - Country:US
Mailing Address - Phone:631-659-3337
Mailing Address - Fax:631-659-3338
Practice Address - Street 1:229 LAUREL RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1100
Practice Address - Country:US
Practice Address - Phone:631-659-3337
Practice Address - Fax:631-659-3338
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst