Basic Information
| Provider Information | |||||||||
| NPI: | 1285933812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELCOURT | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CURTIS | ||||||||
| OtherFirstName: | KIMBERLY | ||||||||
| OtherMiddleName: | D | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | KIMBERLY D. MARTIN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 509 W MCKINLEY AVE | ||||||||
| Address2: | STE 3 | ||||||||
| City: | MISHAWAKA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465455564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742770274 | ||||||||
| FaxNumber: | 5742717202 | ||||||||
| Practice Location | |||||||||
| Address1: | 509 W MCKINLEY AVE | ||||||||
| Address2: | STE 3 | ||||||||
| City: | MISHAWAKA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465455564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742540229 | ||||||||
| FaxNumber: | 5742540188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2011 | ||||||||
| LastUpdateDate: | 10/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | 34007827A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.