Provider Demographics
NPI:1083782320
Name:ZAHLAWAY, KIMBERLY GRACE (LICSW MSW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:GRACE
Last Name:ZAHLAWAY
Suffix:
Gender:F
Credentials:LICSW MSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:GRACE
Other - Last Name:TEBBENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-0169
Mailing Address - Country:US
Mailing Address - Phone:484-321-3034
Mailing Address - Fax:
Practice Address - Street 1:237 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1592
Practice Address - Country:US
Practice Address - Phone:484-321-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1105901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P08698Medicare ID - Type Unspecified