Basic Information
| Provider Information | |||||||||
| NPI: | 1194149062 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAZEN KRIEBEL | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1440 RUSSELL RD | ||||||||
| Address2: | |||||||||
| City: | PAOLI | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193011236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106446464 | ||||||||
| FaxNumber: | 6109816078 | ||||||||
| Practice Location | |||||||||
| Address1: | 1107 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LANSDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194463143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106446464 | ||||||||
| FaxNumber: | 6109816078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2014 | ||||||||
| LastUpdateDate: | 04/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CW017885 | PA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | CW017885 | PA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.