Healthcare Provider Details

I. General information

NPI: 1083273494
Provider Name (Legal Business Name): AMANDA LIEBERMAN KENNEY MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 WIND CHIME CT STE 202
RALEIGH NC
27615-6480
US

IV. Provider business mailing address

189 WIND CHIME CT STE 202
RALEIGH NC
27615-6480
US

V. Phone/Fax

Practice location:
  • Phone: 919-234-5687
  • Fax:
Mailing address:
  • Phone: 919-234-5687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP013852
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC015373
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: