Provider Demographics
NPI:1265283253
Name:STLOUIS, KEBRINA
Entity type:Individual
Prefix:
First Name:KEBRINA
Middle Name:
Last Name:STLOUIS
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 1:839 BAUER ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4316
Mailing Address - Country:US
Mailing Address - Phone:516-424-1040
Mailing Address - Fax:
Practice Address - Street 1:839 BAUER ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4316
Practice Address - Country:US
Practice Address - Phone:516-424-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst