MEDICARE: DR. KIMBERLY VIDONI MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	9771194	ID
2	106H00000X	Marriage & Family Therapist	4179	NV

General Provider Information

NPI Number	:	1588196539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY VIDONI MFT

Provider Business Mailing Address
First Line	:	9 RETAIL RD STE 6
Second Line	:
City	:	DAYTON
State	:	NV
Zip	:	89403-6365
Country	:	US
Telephone Number	:	775-234-8830
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 RETAIL RD STE 6
Second Line	:
City	:	DAYTON
State	:	NV
Zip	:	89403-6365
Country	:	US
Telephone Number	:	775-234-8830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2017
Last Update Date	:	03/03/2026

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