Mary Beth Kibort, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP4224 Issued in MN

Legal business name

MARY BETH KIBORT, LLC

Doing business as

Mary Beth Kibort, Psy.D., LP

Practice address

821 Raymond Ave
Suite 200
Saint Paul, MN 55114-1503

Phone

(651) 645-2890

Fax

(651) 645-4603

NPI assigned

Sep 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mary Beth Kibort, PSY.D.NPI 1285730424

Title

Clinical Psychologist

Phone

(651) 645-2890

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Mary Beth Kibort, Psy.D., LP Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mary Beth Kibort, PSY.D.

  • Clinical Psychologist
  • Saint Paul, MN
  • NPI 1285730424
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336245455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 RAYMOND AVE",
            "address_2": "SUITE 200",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141503",
            "telephone_number": "651-645-2890",
            "fax_number": "651-645-4603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 RAYMOND AVE",
            "address_2": "SUITE 200",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141503",
            "telephone_number": "651-645-2890",
            "fax_number": "651-645-4603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY BETH KIBORT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIBORT",
        "authorized_official_first_name": "MARY BETH",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "651-645-2890",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4224",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "103255",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "330LOKI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA/UBH",
            "identifier": "6157722",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "122502",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary Beth Kibort, Psy.D., LP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly A Martinez, CPNP
• Reid A Martinson, MD
• Rebecca Jo Binder Marturano, OTR/L.
• Kristine Marvin, MD
• Denise A Marvinney, PHD LP
• Mary Clare Lindsley, LLC
• Bridgid Jane Marzen, PTA
• Carrie J Marzolf, PA
• Catherine Barbara Mascari, CERTIFIED NURSE MW
• Karen K Maschka, ROPA

• Clinical Psychologist in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.