Provider Demographics
NPI:1013279231
Name:MARIANI, KIMBERLY (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:MARIANI
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:KALLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ED
Mailing Address - Street 1:6 CRAG CT
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-2314
Mailing Address - Country:US
Mailing Address - Phone:631-587-1329
Mailing Address - Fax:
Practice Address - Street 1:6 CRAG CT
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-2314
Practice Address - Country:US
Practice Address - Phone:631-587-1329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist