Healthcare Provider Details

I. General information

NPI: 1942907373
Provider Name (Legal Business Name): BLAIR LIEBERMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 WINTHROP ST APT X5
BROOKLYN NY
11225-6068
US

IV. Provider business mailing address

80 WINTHROP ST APT X5
BROOKLYN NY
11225-6068
US

V. Phone/Fax

Practice location:
  • Phone: 602-326-7356
  • Fax:
Mailing address:
  • Phone: 602-326-7356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number090390
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: