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General NPI Number Information
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NPI Number | 1508146358
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Entity Type | Individual
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Provider Name | PATRICIA JEANNE LIEBER LICSW
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Gender | Female
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 251 CAUSEWAY ST
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City | BOSTON
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State | MA
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Zip | 02114-2148
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Country | US
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Telephone | 617-248-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 12 POND ST APT 2
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-2505
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Country | US
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Telephone | 617-524-6572
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 104890
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License Number State | MA
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