Provider Demographics
NPI:1285001040
Name:LIEBLING, KATHRINE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHRINE
Middle Name:
Last Name:LIEBLING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHRINE
Other - Middle Name:
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2042
Mailing Address - Country:US
Mailing Address - Phone:631-938-6467
Mailing Address - Fax:
Practice Address - Street 1:115 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2042
Practice Address - Country:US
Practice Address - Phone:631-938-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094988104100000X
171M00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator