Provider Demographics
NPI:1366419244
Name:KILMER, SARAH LIEBMAN (PHD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LIEBMAN
Last Name:KILMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 COPPERFIELD BLVD NE
Mailing Address - Street 2:NE PSYCHIATRIC
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2402
Mailing Address - Country:US
Mailing Address - Phone:704-262-1800
Mailing Address - Fax:704-262-1836
Practice Address - Street 1:380 COPPERFIELD BLVD NE
Practice Address - Street 2:NE PSYCHIATRIC
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2402
Practice Address - Country:US
Practice Address - Phone:704-262-1800
Practice Address - Fax:704-262-1836
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2719103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000580Medicaid
NC2818245AMedicare ID - Type Unspecified