MEDICARE: LIBERTY ARMS COUNSELING LCSW PC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1982568168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY ARMS COUNSELING LCSW PC

Provider Business Mailing Address
First Line	:	83 TIPTON DR E
Second Line	:
City	:	SHIRLEY
State	:	NY
Zip	:	11967-3616
Country	:	US
Telephone Number	:	631-914-9494
Fax Number	:	631-914-9494

Provider Business Practice Location Address
First Line	:	970 SUNRISE HWY
Second Line	:
City	:	WEST BABYLON
State	:	NY
Zip	:	11704-6110
Country	:	US
Telephone Number	:	631-914-9494
Fax Number	:	631-914-9494

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL OF LIBERTY ARMS
Name	:	ROBIN R GARDNER
Credential	:
Telephone Number	:	516-819-9769

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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