Healthcare Provider Details

I. General information

NPI: 1760035836
Provider Name (Legal Business Name): CHRISTINE MARIE LEIBERT PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CENTRAL AVE
LYNN MA
01901-1201
US

IV. Provider business mailing address

23 TURNER ST UNIT 3
SALEM MA
01970-5276
US

V. Phone/Fax

Practice location:
  • Phone: 781-581-3900
  • Fax:
Mailing address:
  • Phone: 978-818-9479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN264691
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number264691
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: