Healthcare Provider Details

I. General information

NPI: 1174579023
Provider Name (Legal Business Name): LARRY A FIEBERT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 W MAIN ST
LANSDALE PA
19446-1303
US

IV. Provider business mailing address

1411 W MAIN ST
LANSDALE PA
19446-1303
US

V. Phone/Fax

Practice location:
  • Phone: 215-362-8665
  • Fax: 215-368-6578
Mailing address:
  • Phone: 215-362-8665
  • Fax: 215-368-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW000266L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: