Healthcare Provider Details

I. General information

NPI: 1093316556
Provider Name (Legal Business Name): JAMIE ROSE LIEBENTRITT MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 09/18/2021
Certification Date: 09/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S 16TH ST STE 201
LINCOLN NE
68502-3704
US

IV. Provider business mailing address

610 J ST STE 210
LINCOLN NE
68508-2967
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-5991
  • Fax:
Mailing address:
  • Phone: 708-732-2387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50082301
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: