MEDICARE: VICKI THERESA LIEBER-SPIESS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	X-10424	NM
2	1041C0700X	Clinical Social Worker	C-12148	NM

General Provider Information

NPI Number	:	1144716119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI THERESA LIEBER-SPIESS LCSW

Provider Business Mailing Address
First Line	:	5640 VENICE AVE NE STE L
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-2350
Country	:	US
Telephone Number	:	505-226-1920
Fax Number	:

Provider Business Practice Location Address
First Line	:	5640 VENICE AVE NE STE L
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-2350
Country	:	US
Telephone Number	:	505-226-1920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	10/24/2023

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