| Doctor Name: | KIMBERLY N. LEATHERDALE |
| NPI Number: | 1497829436 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ATR, LPC |
| License Number: | 37PC00043700 |
| Business Practice Address: | 254 Routes 202 206 Second Floor Pluckemin, NJ - 07978 |
| Business Phone Number: | 9082564779 |
| Business Fax Number: | |
| Mailing Address: | Po Box 87, PLUCKEMIN |
| State: | NJ |
| Postal Code: | 079780087 |
| Phone Number: | 9082564779 |
| Fax Number: | |
| NPI Enumeration Date: | 11/20/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 37PC00043700 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |