Provider Demographics
NPI:1295748887
Name:INFANTI, KIMBERLY S (MED,NBCC, LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:INFANTI
Suffix:
Gender:F
Credentials:MED,NBCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:LEDERACH
Mailing Address - State:PA
Mailing Address - Zip Code:19450-0101
Mailing Address - Country:US
Mailing Address - Phone:215-256-0164
Mailing Address - Fax:215-256-3159
Practice Address - Street 1:690 HARLEYSVILLE PIKE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438
Practice Address - Country:US
Practice Address - Phone:215-256-0164
Practice Address - Fax:215-256-3159
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001440101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional