Provider Demographics
NPI:1548530538
Name:TOLBERT, KRISTIN MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 NORTHLAKE BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1705
Mailing Address - Country:US
Mailing Address - Phone:561-262-6109
Mailing Address - Fax:561-318-5896
Practice Address - Street 1:3309 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1705
Practice Address - Country:US
Practice Address - Phone:561-262-6109
Practice Address - Fax:561-318-5896
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8460103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic