Healthcare Provider Details

I. General information

NPI: 1821412933
Provider Name (Legal Business Name): CAROL H LIEBER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 N DALE MABRY HWY SUITE 330
TAMPA FL
33618-2075
US

IV. Provider business mailing address

11215 CARROLLWOOD DR
TAMPA FL
33618-3701
US

V. Phone/Fax

Practice location:
  • Phone: 813-968-9600
  • Fax:
Mailing address:
  • Phone: 813-956-7586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11490
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: