Healthcare Provider Details

I. General information

NPI: 1033123328
Provider Name (Legal Business Name): KIMBERLY A BONVINO PH.D. LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 BETHLEHEM PIKE STE 400
MONTGOMERYVILLE PA
18936-1301
US

IV. Provider business mailing address

21 HOLLAND DR
CHALFONT PA
18914-2701
US

V. Phone/Fax

Practice location:
  • Phone: 267-994-1847
  • Fax:
Mailing address:
  • Phone: 267-994-1847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC003417
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC003417
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC003417
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: