MEDICARE: JOANN LIBERTA PMHNP-BC

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	163W00000X	Registered Nurse	493443	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	402190	NY

General Provider Information

NPI Number	:	1205382165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANN LIBERTA PMHNP-BC

Provider Business Mailing Address
First Line	:	66 WESTCLIFF DR
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-2838
Country	:	US
Telephone Number	:	716-536-4659
Fax Number	:

Provider Business Practice Location Address
First Line	:	3911 N BUFFALO ST
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-1841
Country	:	US
Telephone Number	:	716-320-7949
Fax Number	:

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

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	07/19/2022

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