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General NPI Number Information
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NPI Number | 1205382165
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Entity Type | Individual
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Provider Name | JOANN LIBERTA PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 3911 N BUFFALO ST
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City | ORCHARD PARK
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State | NY
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Zip | 14127-1841
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Country | US
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Telephone | 716-320-7949
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Fax |
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Provider Business Mailing Address
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Address Line | 66 WESTCLIFF DR
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City | WEST SENECA
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State | NY
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Zip | 14224-2838
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Country | US
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Telephone | 716-536-4659
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 493443
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 402190
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License Number State | NY
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