Healthcare Provider Details

I. General information

NPI: 1720867401
Provider Name (Legal Business Name): ELLYN LEIBOWITZ LPC, ACS, CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELLEN LEIBOWITZ

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 CONSTITUTION AVE
BAYONNE NJ
07002-5091
US

IV. Provider business mailing address

301 CONSTITUTION AVE
BAYONNE NJ
07002-5091
US

V. Phone/Fax

Practice location:
  • Phone: 862-576-1120
  • Fax:
Mailing address:
  • Phone: 862-576-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00654300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: