Basic Information
| Provider Information | |||||||||
| NPI: | 1265719314 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIEBERMAN | ||||||||
| FirstName: | BEATRICE | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 243 W 71ST ST APT 4R | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100233742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6467348691 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2020 CONEY ISLAND AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112232329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186764260 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2011 | ||||||||
| LastUpdateDate: | 11/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 021228-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.