Healthcare Provider Details

I. General information

NPI: 1275587081
Provider Name (Legal Business Name): MARILYN LIEBERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W 13TH ST
NEW YORK NY
10011-7802
US

IV. Provider business mailing address

150 W 13TH ST
NEW YORK NY
10011-7802
US

V. Phone/Fax

Practice location:
  • Phone: 718-275-3646
  • Fax:
Mailing address:
  • Phone: 718-275-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number070187
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: