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General NPI Number Information
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NPI Number | 1700103157
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Entity Type | Individual
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Provider Name | KIMBERLY ANN RIDER M.S
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Gender | Female
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Dates
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Enumeration Date | 04/26/2010
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Last Update Date | 04/26/2010
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Provider Practice Location Address
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Address Line | 1085 US ROUTE 4 E SUITE 2A
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City | RUTLAND
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State | VT
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Zip | 05701-8860
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Country | US
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Telephone | 802-775-6331
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Fax | 802-775-6373
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Provider Business Mailing Address
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Address Line | 1085 US ROUTE 4 E SUITE 2A
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City | RUTLAND
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State | VT
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Zip | 05701-8860
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Country | US
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Telephone | 802-775-6331
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Fax | 802-775-6373
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 047,0057915
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License Number State | VT
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