Provider Demographics
NPI:1487888459
Name:LIEBERT, PHYLLIS FARKAS (MS,RD,LDN)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:FARKAS
Last Name:LIEBERT
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CONSHOHOCKEN STATE RD
Mailing Address - Street 2:#601
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2438
Mailing Address - Country:US
Mailing Address - Phone:610-664-9994
Mailing Address - Fax:610-664-9994
Practice Address - Street 1:41 CONSHOHOCKEN STATE RD
Practice Address - Street 2:#601
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2438
Practice Address - Country:US
Practice Address - Phone:610-664-9994
Practice Address - Fax:610-664-9994
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAR-204004133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA204004OtherREGISTERED DIETITIAN, AMERICAN DIETETIC ASSOCIATION