# MITCHELL C. LISS, PSY.D., LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124512785
- **Authorized official:** MITCHELL CRAIG LISS PSY.D. (PSYCHOLOGIST)
- **Authorized official phone:** (215) 869-8195

## Contact information

- **Practice address:** 1101 KINGS HWY N STE 313, CHERRY HILL, NJ 08034
- **Practice address phone:** (215) 869-8195
- **Mailing address:** 1101 KINGS HWY N STE 313, CHERRY HILL, NJ 08034-1912
- **Mailing address phone:** (215) 869-8195

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 06/18/2018
- **Last updated:** 12/10/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1235592320 | NPI | NJ |