Healthcare Provider Details

I. General information

NPI: 1508146358
Provider Name (Legal Business Name): PATRICIA JEANNE LIEBER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 CAUSEWAY ST
BOSTON MA
02114-2148
US

IV. Provider business mailing address

12 POND ST APT 2
JAMAICA PLAIN MA
02130-2505
US

V. Phone/Fax

Practice location:
  • Phone: 617-248-1000
  • Fax:
Mailing address:
  • Phone: 617-524-6572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104890
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: