Provider Demographics
NPI:1063439933
Name:LIEVENDAG, JESSICA E (MA, LPC,)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:LIEVENDAG
Suffix:
Gender:F
Credentials:MA, LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 S CEDAR CREST BLVD STE 3A
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6207
Mailing Address - Country:US
Mailing Address - Phone:610-351-3477
Mailing Address - Fax:610-351-3488
Practice Address - Street 1:1275 S CEDAR CREST BLVD STE 3A
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6207
Practice Address - Country:US
Practice Address - Phone:610-351-3477
Practice Address - Fax:610-351-3488
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
2321921000OtherAMERIHEALTH PIN
7352529OtherAETNA PIN
001663343OtherPERSONAL CHOICE PIN
547210000OtherMAGELLAN MIS
565080OtherVALUE OPTIONS MHS
50001253OtherCAPITAL BLUE CROSS PIN