Provider Demographics
NPI:1164721684
Name:MARY LIEBERMANN, INC.
Entity Type:Organization
Organization Name:MARY LIEBERMANN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-306-7830
Mailing Address - Street 1:1307 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-2620
Mailing Address - Country:US
Mailing Address - Phone:407-719-7749
Mailing Address - Fax:
Practice Address - Street 1:1307 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-2620
Practice Address - Country:US
Practice Address - Phone:407-719-7749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW31091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty