Provider Demographics
NPI:1013573534
Name:LEIBOWITZ, LOUIS R (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:R
Last Name:LEIBOWITZ
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7090 SAMUEL MORSE DR STE 100-300
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3442
Mailing Address - Country:US
Mailing Address - Phone:443-386-6752
Mailing Address - Fax:
Practice Address - Street 1:7090 SAMUEL MORSE DR STE 100-300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3442
Practice Address - Country:US
Practice Address - Phone:443-386-6752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA580103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst