Provider Demographics
NPI:1225589013
Name:LIBBY, ANNE (LCSW CASAC NBCCH MA)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:LIBBY
Suffix:
Gender:F
Credentials:LCSW CASAC NBCCH MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 PINE CREST LN
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-2718
Mailing Address - Country:US
Mailing Address - Phone:917-520-1508
Mailing Address - Fax:
Practice Address - Street 1:44 PINE CREST LN
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-2718
Practice Address - Country:US
Practice Address - Phone:917-520-1508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8864961861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical