Provider Demographics
NPI:1376862649
Name:DELANEY, KIMBERLY MARIE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARIE
Last Name:DELANEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 ANDOVER PARK W STE 107
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3911
Mailing Address - Country:US
Mailing Address - Phone:253-590-6089
Mailing Address - Fax:
Practice Address - Street 1:3436 MARY ELDER RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5050
Practice Address - Country:US
Practice Address - Phone:360-528-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC 70042OtherSANTA CRUZ COUNTY MEDI-CAL GROUP PROVIDER#
CAZZZ91891ZOtherSANTA CRUZ COUNTY MEDICARE GROUP#
CAFHC 70044FOtherSANTA CRUZ COUNTY MEDI-CAL GROUP PROVIDER#
CAZZZ92069ZOtherSANTA CRUZ COUNTY MEDICARE GROUP#
CAZZZ91892ZOtherSANTA CRUZ COUNTY MEDICARE GROUP#