Healthcare Provider Details

I. General information

NPI: 1861012924
Provider Name (Legal Business Name): MIRIAM LIEBERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2020
Last Update Date: 04/19/2020
Certification Date: 04/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W END AVE APT 1B
NEW YORK NY
10023-0137
US

IV. Provider business mailing address

800 W END AVE # 5C
NEW YORK NY
10025-5467
US

V. Phone/Fax

Practice location:
  • Phone: 917-915-1590
  • Fax:
Mailing address:
  • Phone: 917-915-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number035036
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: