Healthcare Provider Details

I. General information

NPI: 1356360846
Provider Name (Legal Business Name): DALE N. LIEBMAN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CHURCH LN STE.206
PIKESVILLE MD
21208-3786
US

IV. Provider business mailing address

3704 BIRCHMERE CT
OWINGS MILLS MD
21117-1256
US

V. Phone/Fax

Practice location:
  • Phone: 410-484-7024
  • Fax: 410-653-5215
Mailing address:
  • Phone: 410-356-3056
  • Fax: 410-653-5215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number02757
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: