Healthcare Provider Details

I. General information

NPI: 1366441214
Provider Name (Legal Business Name): JILL LIEBER LCSWR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 N FOREST RD STE 140
GETZVILLE NY
14068-1557
US

IV. Provider business mailing address

2430 N FOREST RD STE 140
GETZVILLE NY
14068-1557
US

V. Phone/Fax

Practice location:
  • Phone: 716-688-5372
  • Fax: 716-688-5327
Mailing address:
  • Phone: 716-688-5372
  • Fax: 716-688-5327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR043130-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: