Healthcare Provider Details

I. General information

NPI: 1598181877
Provider Name (Legal Business Name): KIMBERLY L REHAK BCBA-D, EDD, LBS, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date: 09/13/2018
Reactivation Date: 12/19/2023

III. Provider practice location address

1044 RUNAWAY DR
PENNSBURG PA
18073-1649
US

IV. Provider business mailing address

1044 RUNAWAY DR
PENNSBURG PA
18073-1649
US

V. Phone/Fax

Practice location:
  • Phone: 215-939-7898
  • Fax:
Mailing address:
  • Phone: 215-939-7898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC010333
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-07-3573
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBH00023
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: