Healthcare Provider Details

I. General information

NPI: 1881356830
Provider Name (Legal Business Name): ASKLEIBCOM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3 BREWSTER AVE
NORTHPORT NY
11768-2616
US

IV. Provider business mailing address

3 BREWSTER AVE
NORTHPORT NY
11768-2616
US

V. Phone/Fax

Practice location:
  • Phone: 631-678-5794
  • Fax:
Mailing address:
  • Phone: 631-678-5794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA MARIE LEIB
Title or Position: PRESIDENT
Credential: LMSW
Phone: 631-678-5794