Healthcare Provider Details

I. General information

NPI: 1467034793
Provider Name (Legal Business Name): MOLLY LIEBERZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 5TH AVE FL 2
NEW YORK NY
10011-5611
US

IV. Provider business mailing address

1 FOX HOLLOW CT
DIX HILLS NY
11746-6161
US

V. Phone/Fax

Practice location:
  • Phone: 347-871-3447
  • Fax:
Mailing address:
  • Phone: 631-742-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: