Healthcare Provider Details

I. General information

NPI: 1730271552
Provider Name (Legal Business Name): LYNN LEIBOWITZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 E. 11TH STREET SUITE #629
NEW YORK NY
10003
US

IV. Provider business mailing address

79 W. 12TH STREET APT. #12E
NEW YORK NY
10011-8565
US

V. Phone/Fax

Practice location:
  • Phone: 212-675-3231
  • Fax: 212-675-2354
Mailing address:
  • Phone: 212-675-3231
  • Fax: 212-675-2354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number6676-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: