1508174756 NPI number — KIMBERLY BENJAMIN L.P.C,, M.ED., CAC

Table of content: KIMBERLY BENJAMIN L.P.C,, M.ED., CAC (NPI 1508174756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508174756 NPI number — KIMBERLY BENJAMIN L.P.C,, M.ED., CAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENJAMIN
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.P.C,, M.ED., CAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508174756
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
723 ARDMORE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARDMORE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19003-1835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-256-4265
Provider Business Mailing Address Fax Number:
610-645-9474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 PLYMOUTH RD
Provider Second Line Business Practice Location Address:
SUITE 106, DOOR F
Provider Business Practice Location Address City Name:
PLYMOUTH MEETING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19462-1638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-265-6464
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  0000095 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com