Healthcare Provider Details

I. General information

NPI: 1700796489
Provider Name (Legal Business Name): REBECCA LEIGH KILDOO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1178 BROADWAY FL FI3
NEW YORK NY
10001-5404
US

IV. Provider business mailing address

380 MATHER ST APT 2305
HAMDEN CT
06514-3156
US

V. Phone/Fax

Practice location:
  • Phone: 917-284-9393
  • Fax:
Mailing address:
  • Phone: 210-777-2367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberK4307320495006
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: