Provider Demographics
NPI:1326239864
Name:LIBERTOFF, JAMIE NATHANIEL (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:NATHANIEL
Last Name:LIBERTOFF
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 HOFFMAN DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6065
Mailing Address - Country:US
Mailing Address - Phone:550-982-8870
Mailing Address - Fax:505-982-0620
Practice Address - Street 1:2001 N. CENTRO FAMILIAR SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105
Practice Address - Country:US
Practice Address - Phone:505-452-4028
Practice Address - Fax:505-877-4400
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-071741041C0700X
NMM06343101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health