Provider Demographics
NPI:1164681839
Name:LIEBENBERG, KATHRYN LAUREN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LAUREN
Last Name:LIEBENBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 KINGS HWY N
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-2443
Mailing Address - Country:US
Mailing Address - Phone:646-734-6672
Mailing Address - Fax:
Practice Address - Street 1:166 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2443
Practice Address - Country:US
Practice Address - Phone:646-734-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017563-1103T00000X
CT002997103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist