MEDICARE: MARY LIEBERMANN, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW3109	FL

General Provider Information

NPI Number	:	1164721684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY LIEBERMANN, INC.

Provider Business Mailing Address
First Line	:	1307 PORTLAND AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-2620
Country	:	US
Telephone Number	:	407-719-7749
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 PORTLAND AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-2620
Country	:	US
Telephone Number	:	407-719-7749
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/PSYCHOTHERAPIST
Name	:	MARY LIEBERMANN
Credential	:
Telephone Number	:	321-306-7830

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	03/24/2023

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