Provider Demographics
NPI:1215918099
Name:GIULIANI, KIMBERLY R (PHD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:GIULIANI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:R
Other - Last Name:STODDARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1136 VINTNER BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-1533
Mailing Address - Country:US
Mailing Address - Phone:561-691-0704
Mailing Address - Fax:
Practice Address - Street 1:1136 VINTNER BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-1533
Practice Address - Country:US
Practice Address - Phone:561-691-0704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002153103T00000X
FLPY7682103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004187656Medicaid
FLAQ690Medicare PIN