Healthcare Provider Details

I. General information

NPI: 1366086472
Provider Name (Legal Business Name): JANNETH LIBORIO-LULO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 JEFFERSON BLVD STE B195
WEST SACRAMENTO CA
95605-2350
US

IV. Provider business mailing address

PO BOX 245483
SACRAMENTO CA
95824-5483
US

V. Phone/Fax

Practice location:
  • Phone: 866-268-4489
  • Fax:
Mailing address:
  • Phone: 916-905-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: