Healthcare Provider Details

I. General information

NPI: 1700348943
Provider Name (Legal Business Name): JOY LIEBERTHAL RHO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 ARDSLEY RD
SCARSDALE NY
10583-2625
US

IV. Provider business mailing address

500 CENTRAL PARK AVE APT 223
SCARSDALE NY
10583-1061
US

V. Phone/Fax

Practice location:
  • Phone: 917-797-1945
  • Fax:
Mailing address:
  • Phone: 917-797-1945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number072269
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: