Provider Demographics
NPI:1033123328
Name:BONVINO, KIMBERLY A (PHD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:BONVINO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-2701
Mailing Address - Country:US
Mailing Address - Phone:267-994-1847
Mailing Address - Fax:
Practice Address - Street 1:587 BETHLEHEM PIKE STE 400
Practice Address - Street 2:
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936-1301
Practice Address - Country:US
Practice Address - Phone:267-994-1847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003417101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA835262000OtherMAGELLAN BEHAVIORAL HEALT