Healthcare Provider Details

I. General information

NPI: 1659716272
Provider Name (Legal Business Name): DR. LUCY R. LEIBOWITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUCY R. BUCHHOLZ

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8821 COLUMBIA 100 PARKWAY
COLUMBIA MD
21045
US

IV. Provider business mailing address

8821 COLUMBIA 100 PARKWAY
COLUMBIA MD
21045
US

V. Phone/Fax

Practice location:
  • Phone: 410-794-4924
  • Fax: 667-200-5953
Mailing address:
  • Phone: 410-794-4924
  • Fax: 667-200-5953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: