Provider Demographics
NPI:1366518847
Name:JONES, KIMBERLY TOLAND (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:TOLAND
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W LANCASTER AVE
Mailing Address - Street 2:2ND FL LOWER MERION COUNSELING SERVICES
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3220
Mailing Address - Country:US
Mailing Address - Phone:610-520-1510
Mailing Address - Fax:610-520-1517
Practice Address - Street 1:850 W LANCASTER AVE
Practice Address - Street 2:2ND FL LOWER MERION COUNSELING SERVICES
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3220
Practice Address - Country:US
Practice Address - Phone:610-520-1510
Practice Address - Fax:610-520-1517
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056536L2084A0401X, 2084P0802X, 2084P0800X
NJ25MA088324002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001606262Medicaid
PA001606262Medicaid
95150Medicare PIN
PA951500Medicare PIN
G52019Medicare UPIN