Provider Demographics
NPI:1811989338
Name:KITTAY, BURTON A (PHD)
Entity type:Individual
Prefix:DR
First Name:BURTON
Middle Name:A
Last Name:KITTAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5350 S STAPLES ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4682
Mailing Address - Country:US
Mailing Address - Phone:361-992-2244
Mailing Address - Fax:361-992-3355
Practice Address - Street 1:5402 HOLLY RD
Practice Address - Street 2:STE 104
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4674
Practice Address - Country:US
Practice Address - Phone:361-992-7780
Practice Address - Fax:361-992-3355
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24966103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035994501Medicaid
TX00T42AMedicare PIN
TXR15016Medicare UPIN