1285933812 NPI number — MRS. KIMBERLY D DELCOURT MSW, LCSW

Table of content: MRS. KIMBERLY D DELCOURT MSW, LCSW (NPI 1285933812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285933812 NPI number — MRS. KIMBERLY D DELCOURT MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELCOURT
Provider First Name:
KIMBERLY
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CURTIS
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
KIMBERLY D. MARTIN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285933812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
509 W MCKINLEY AVE
Provider Second Line Business Mailing Address:
STE 3
Provider Business Mailing Address City Name:
MISHAWAKA
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46545-5564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-277-0274
Provider Business Mailing Address Fax Number:
574-271-7202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 W MCKINLEY AVE
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
MISHAWAKA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46545-5564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-254-0229
Provider Business Practice Location Address Fax Number:
574-254-0188
Provider Enumeration Date:
03/22/2011

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 34007827A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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