Provider Demographics
NPI:1588998900
Name:DU, KIMBERLY S (MA, MT-BC, LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:DU
Suffix:
Gender:F
Credentials:MA, MT-BC, LPC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LO
Other - Last Name:STUDEBAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:322 OVERLOOK LN
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428
Mailing Address - Country:US
Mailing Address - Phone:215-219-4556
Mailing Address - Fax:
Practice Address - Street 1:322 OVERLOOK LN
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428
Practice Address - Country:US
Practice Address - Phone:484-580-9340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X
PAPC005895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist