Healthcare Provider Details

I. General information

NPI: 1982568168
Provider Name (Legal Business Name): LIBERTY ARMS COUNSELING LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 SUNRISE HWY
WEST BABYLON NY
11704-6110
US

IV. Provider business mailing address

83 TIPTON DR E
SHIRLEY NY
11967-3616
US

V. Phone/Fax

Practice location:
  • Phone: 631-914-9494
  • Fax: 631-914-9494
Mailing address:
  • Phone: 631-914-9494
  • Fax: 631-914-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ROBIN R GARDNER
Title or Position: AUTHORIZED OFFICIAL OF LIBERTY ARMS
Credential:
Phone: 516-819-9769