Healthcare Provider Details

I. General information

NPI: 1356561369
Provider Name (Legal Business Name): AMY LIEBERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E 37TH ST LOBBY, SUITE A
NEW YORK NY
10016-3156
US

IV. Provider business mailing address

60 HAMILTON AVE
HASTINGS ON HUDSON NY
10706-3120
US

V. Phone/Fax

Practice location:
  • Phone: 212-889-4008
  • Fax:
Mailing address:
  • Phone: 914-478-1078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number039336
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: