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NPI Code Detail

MEDICARE: CHRYSTAL DAWN LIEBOLD-JOHNSON LCSW

MEDICARE: CHRYSTAL DAWN LIEBOLD-JOHNSON LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker77002CA

General Provider Information

NPI Number : 1578092979
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRYSTAL DAWN LIEBOLD-JOHNSON LCSW
Provider Business Mailing Address
First Line : 4529 SAINT DAVIDS ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19127-1216
Country : US
Telephone Number : 646-957-4294
Fax Number :
Provider Business Practice Location Address
First Line : 4529 SAINT DAVIDS ST UNIT 101
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19127-1216
Country : US
Telephone Number : 646-957-4294
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2017
Last Update Date : 02/12/2026

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