Healthcare Provider Details

I. General information

NPI: 1104739390
Provider Name (Legal Business Name): MS. KIMBERLY DELUDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 TOWN CRIER DR
BRATTLEBORO VT
05301-8669
US

IV. Provider business mailing address

16 TOWN CRIER DR
BRATTLEBORO VT
05301-8669
US

V. Phone/Fax

Practice location:
  • Phone: 802-689-8900
  • Fax:
Mailing address:
  • Phone: 802-258-4623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: