Provider Demographics
NPI:1386888782
Name:WETHERILL, LIBERTY HERKNESS (MA)
Entity type:Individual
Prefix:MS
First Name:LIBERTY
Middle Name:HERKNESS
Last Name:WETHERILL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 DREW AVENUE
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081
Mailing Address - Country:US
Mailing Address - Phone:610-420-6798
Mailing Address - Fax:
Practice Address - Street 1:36 EAST FRONT STREET
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:610-420-6798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health