Healthcare Provider Details

I. General information

NPI: 1841876133
Provider Name (Legal Business Name): WILLIAM LIEDER LCSW-BACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 METAIRIE RD. STE 1B102 #552923
METAIRIE LA
70005
US

IV. Provider business mailing address

701 METAIRIE RD. STE 1B102 #552923
METAIRIE LA
70005
US

V. Phone/Fax

Practice location:
  • Phone: 504-866-9622
  • Fax:
Mailing address:
  • Phone: 504-866-9622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4575
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: