Provider Demographics
NPI:1275772089
Name:GROVES, KIMBERLY LAUREN (PSYD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LAUREN
Last Name:GROVES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LAUREN
Other - Last Name:SCHREYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:168 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1686
Mailing Address - Country:US
Mailing Address - Phone:609-678-8331
Mailing Address - Fax:
Practice Address - Street 1:385 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1013
Practice Address - Country:US
Practice Address - Phone:856-220-9672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5247103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist