Provider Demographics
NPI:1508174756
Name:BENJAMIN, KIMBERLY (LPC,, MED, CAC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:LPC,, MED, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1835
Mailing Address - Country:US
Mailing Address - Phone:610-256-4265
Mailing Address - Fax:610-645-9474
Practice Address - Street 1:521 PLYMOUTH RD
Practice Address - Street 2:SUITE 106, DOOR F
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1638
Practice Address - Country:US
Practice Address - Phone:610-265-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0000095101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor