Provider Demographics
NPI:1417066770
Name:LIEBERMAN, GLENN S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:S
Last Name:LIEBERMAN
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 1:16 LEROY STREET
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4603
Mailing Address - Country:US
Mailing Address - Phone:607-765-0033
Mailing Address - Fax:607-217-7382
Practice Address - Street 1:16 LEROY STREET
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905
Practice Address - Country:US
Practice Address - Phone:607-765-0033
Practice Address - Fax:607-217-7382
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR033334-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52375BMedicare ID - Type Unspecified