Provider Demographics
NPI:1912913237
Name:TRIEBWASSER, KATHLEEN F (LMFT LMHC CCMHC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:F
Last Name:TRIEBWASSER
Suffix:
Gender:F
Credentials:LMFT LMHC CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 CYPRESS PLAZA DR
Mailing Address - Street 2:ST, 109
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4420
Mailing Address - Country:US
Mailing Address - Phone:904-641-4600
Mailing Address - Fax:904-542-9800
Practice Address - Street 1:8301 CYPRESS PLAZA DR
Practice Address - Street 2:ST, 109
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4420
Practice Address - Country:US
Practice Address - Phone:904-641-4600
Practice Address - Fax:904-542-9800
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1685 MH3580101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health