Provider Demographics
NPI:1326429119
Name:DINELLE, KIM MARIE (PSYCHIATRIC NP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:DINELLE
Suffix:
Gender:F
Credentials:PSYCHIATRIC NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 STRACK DR
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-1596
Mailing Address - Country:US
Mailing Address - Phone:845-831-4800
Mailing Address - Fax:
Practice Address - Street 1:18 STRACK DR
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-1596
Practice Address - Country:US
Practice Address - Phone:845-831-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401829-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health