Healthcare Provider Details

I. General information

NPI: 1588998900
Provider Name (Legal Business Name): KIMBERLY S DU MA, MT-BC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY LO STUDEBAKER

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 OVERLOOK LN
CONSHOHOCKEN PA
19428
US

IV. Provider business mailing address

322 OVERLOOK LN
CONSHOHOCKEN PA
19428
US

V. Phone/Fax

Practice location:
  • Phone: 484-580-9340
  • Fax:
Mailing address:
  • Phone: 215-219-4556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC005895
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: