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General NPI Number Information
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NPI Number | 1881881852
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Entity Type | Individual
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Provider Name | JESSICA LEIBOWITZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 98120 QUEENS BLVD
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City | REGO PARK
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State | NY
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Zip | 11374
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Country | US
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Telephone | 718-830-0234
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Fax |
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Provider Business Mailing Address
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Address Line | 2 OVERLOOK RD APT 1C5
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City | WHITE PLAINS
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State | NY
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Zip | 10605-2432
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Country | US
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Telephone | 914-714-2339
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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 | 086677
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 079510
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0090954
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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