Kimberly Rebolledo

Key facts

NPI

1336722610

Entity type

Individual (NPI type 1)

Primary specialty

Behavior Analyst 103K00000X

License

1-21-48469 (NJ)

Practice address

125 Half Mile Rd Ste 200
Red Bank, NJ 07701-6749

Phone

(855) 832-6727

Fax

(772) 675-9100

NPI assigned

May 4, 2021

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 4, 2021.

{
    "created_epoch": "1620086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620086400000",
    "number": "1336722610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7108 S KANNER HWY",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349977462",
            "telephone_number": "855-832-6727",
            "fax_number": "772-675-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 HALF MILE RD STE 200",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077016749",
            "telephone_number": "855-832-6727",
            "fax_number": "772-675-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REBOLLEDO",
        "first_name": "KIMBERLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-04",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NJ",
            "license": "1-21-48469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Red Bank, NJ · Behavior Analyst in New Jersey