MEDICARE: FRANC JOHN LIBIHOUL L.C.S.W.

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	037837-R	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669555439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANC JOHN LIBIHOUL L.C.S.W.

Provider Business Mailing Address
First Line	:	124 GREEN ST
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-4422
Country	:	US
Telephone Number	:	845-331-3001
Fax Number	:	845-335-4600

Provider Business Practice Location Address
First Line	:	319 BROADWAY
Second Line	:
City	:	PORT EWEN
State	:	NY
Zip	:	12466
Country	:	US
Telephone Number	:	845-339-8707
Fax Number	:	845-339-2610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	06/26/2019

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