1518032838 NPI number — MS. KIMBERLEY ANN HARTELL LMFT

Table of content: MS. KIMBERLEY ANN HARTELL LMFT (NPI 1518032838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518032838 NPI number — MS. KIMBERLEY ANN HARTELL LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTELL
Provider First Name:
KIMBERLEY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARTELL-BRITT
Provider Other First Name:
KIMBERLEY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518032838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
273 LOWER HYDE PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE RIVER JUNCTION
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05001-6098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-291-3808
Provider Business Mailing Address Fax Number:
802-698-8220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE #27
Provider Business Practice Location Address City Name:
WHITE RIVER JUNCTION
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05001-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-291-3808
Provider Business Practice Location Address Fax Number:
802-698-8220
Provider Enumeration Date:
11/21/2006

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: 106H00000X , with the licence number:  100.0000045 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1011545 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com