Provider Demographics
NPI:1205581246
Name:KOTURO, KIM (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:KOTURO
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 DANEMAR DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-3607
Mailing Address - Country:US
Mailing Address - Phone:732-687-1517
Mailing Address - Fax:
Practice Address - Street 1:13 DANEMAR DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-3607
Practice Address - Country:US
Practice Address - Phone:732-687-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ342765103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool