Healthcare Provider Details

I. General information

NPI: 1205901386
Provider Name (Legal Business Name): LINDA UCKO LEIBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 MILLBURN AVE
SPRINGFIELD NJ
07081-1039
US

IV. Provider business mailing address

28 MILLBURN AVE
SPRINGFIELD NJ
07081-1039
US

V. Phone/Fax

Practice location:
  • Phone: 973-467-9333
  • Fax: 973-467-1145
Mailing address:
  • Phone: 973-467-9333
  • Fax: 973-467-1145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00528300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: