Provider Demographics
NPI:1497314199
Name:KIMBROUGH, STELLA (MSW)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:KIMBROUGH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BENTLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2805
Mailing Address - Country:US
Mailing Address - Phone:484-802-8454
Mailing Address - Fax:
Practice Address - Street 1:19 ELLIOTT AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3407
Practice Address - Country:US
Practice Address - Phone:484-466-6302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker