Healthcare Provider Details

I. General information

NPI: 1285826602
Provider Name (Legal Business Name): MARY LIEBERMANN L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 03/24/2023
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 PORTLAND AVE
ORLANDO FL
32803-2620
US

IV. Provider business mailing address

1307 PORTLAND AVE
ORLANDO FL
32803-2620
US

V. Phone/Fax

Practice location:
  • Phone: 321-306-7830
  • Fax: 407-893-5775
Mailing address:
  • Phone: 321-306-7830
  • Fax: 407-893-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW3109
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: