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General NPI Number Information
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NPI Number | 1477858694
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Entity Type | Organization
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Legal Business Name | CATHERINE A LIEBHAUSER MD LLC
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 24 PORTLAND PL
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2822
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Country | US
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Telephone | 973-746-7712
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Fax | 201-462-3847
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Provider Business Mailing Address
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Address Line | 10 CRESTMONT RD APT 6R
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City | MONTCLAIR
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State | NJ
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Zip | 07042-1936
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Country | US
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Telephone | 973-746-7712
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Fax | 201-462-3847
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Authorized Official
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Title or Position | OWNER
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Name | CATHERINE A LIEBHAUSER
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Credential | MD
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Telephone | 973-746-7712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MA56760
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License Number State | NJ
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