Healthcare Provider Details

I. General information

NPI: 1457635104
Provider Name (Legal Business Name): EMILY ELIZABETH LIEBER LCSW, TYPE 73
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 DAVIS ST
EVANSTON IL
60201-4431
US

IV. Provider business mailing address

820 DAVIS ST
EVANSTON IL
60201-4431
US

V. Phone/Fax

Practice location:
  • Phone: 773-726-1840
  • Fax:
Mailing address:
  • Phone: 773-726-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.014845
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: