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General NPI Number Information
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NPI Number | 1447828231
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Entity Type | Individual
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Provider Name | JESSICA ANN LIBURDI
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Gender | Female
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 115 FALL ST
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City | SENECA FALLS
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State | NY
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Zip | 13148-1498
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Country | US
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Telephone | 315-515-5194
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Fax |
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Provider Business Mailing Address
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Address Line | 114 KENWOOD CT
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City | LATHAM
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State | NY
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Zip | 12110-3757
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Country | US
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Telephone | 518-269-1676
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | P109517
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License Number State | NY
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