Provider Demographics
NPI:1932393725
Name:BURBY, KI-YOUNG
Entity Type:Individual
Prefix:
First Name:KI-YOUNG
Middle Name:
Last Name:BURBY
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 1:29 GILMAN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-1011
Mailing Address - Country:US
Mailing Address - Phone:203-291-0298
Mailing Address - Fax:
Practice Address - Street 1:29 GILMAN ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-1011
Practice Address - Country:US
Practice Address - Phone:860-291-0298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health