Provider Demographics
NPI:1902366271
Name:REALBUTO, KIMBERLY MAY
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MAY
Last Name:REALBUTO
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 1:1700 OLD ORCHARD STREET
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10594
Mailing Address - Country:US
Mailing Address - Phone:914-949-0665
Mailing Address - Fax:
Practice Address - Street 1:1700 OLD ORCHARD STREET
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10594
Practice Address - Country:US
Practice Address - Phone:914-949-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty