Provider Demographics
NPI:1518032838
Name:HARTELL, KIMBERLEY ANN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:ANN
Last Name:HARTELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:ANN
Other - Last Name:HARTELL-BRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:273 LOWER HYDE PARK
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-6098
Mailing Address - Country:US
Mailing Address - Phone:802-291-3808
Mailing Address - Fax:802-698-8220
Practice Address - Street 1:1011 N MAIN ST
Practice Address - Street 2:SUITE #27
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-6200
Practice Address - Country:US
Practice Address - Phone:802-291-3808
Practice Address - Fax:802-698-8220
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT100.0000045106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011545Medicaid