1104267798 NPI number — KIMBERLY A RINKO LCSW,MSW,BA

Table of content: KIMBERLY A RINKO LCSW,MSW,BA (NPI 1104267798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104267798 NPI number — KIMBERLY A RINKO LCSW,MSW,BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RINKO
Provider First Name:
KIMBERLY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW,MSW,BA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104267798
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1064
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06721-1064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-980-3850
Provider Business Mailing Address Fax Number:
203-405-2238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 STRAITS TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06762-2865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-598-4492
Provider Business Practice Location Address Fax Number:
203-405-3328
Provider Enumeration Date:
07/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  00837 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008049703 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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