Healthcare Provider Details

I. General information

NPI: 1609016039
Provider Name (Legal Business Name): JENNIFER COWING LIEBER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 E 12TH ST SUITE 1E
NEW YORK NY
10003-4623
US

IV. Provider business mailing address

31 E 12TH ST SUITE 1E
NEW YORK NY
10003-4623
US

V. Phone/Fax

Practice location:
  • Phone: 646-621-0414
  • Fax: 212-475-0414
Mailing address:
  • Phone: 646-621-0414
  • Fax: 212-475-0414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number73050885
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: