Healthcare Provider Details

I. General information

NPI: 1104159961
Provider Name (Legal Business Name): KRISTIN ELIZABETH LIEBERMAN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 02/25/2024
Certification Date: 02/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 S MAPLE AVE STE 205
MARLTON NJ
08053-2002
US

IV. Provider business mailing address

26 S MAPLE AVE STE 205
MARLTON NJ
08053-2002
US

V. Phone/Fax

Practice location:
  • Phone: 856-878-2624
  • Fax:
Mailing address:
  • Phone: 856-878-2624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: