Healthcare Provider Details

I. General information

NPI: 1528753555
Provider Name (Legal Business Name): KIMBERLY ROTFELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 CREAMERY WAY
EXTON PA
19341-2508
US

IV. Provider business mailing address

900 CHISWELL DR
DOWNINGTOWN PA
19335-4151
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-1488
  • Fax:
Mailing address:
  • Phone: 267-516-3264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC015343
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC015343
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: