Provider Demographics
NPI:1922861178
Name:LIEBERSOHN, TESS L (MED, LPC)
Entity Type:Individual
Prefix:
First Name:TESS
Middle Name:L
Last Name:LIEBERSOHN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4617 PINE ST APT H103
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1832
Mailing Address - Country:US
Mailing Address - Phone:215-837-4224
Mailing Address - Fax:
Practice Address - Street 1:4617 PINE ST APT H103
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1832
Practice Address - Country:US
Practice Address - Phone:215-837-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional