Provider Demographics
NPI:1477858694
Name:CATHERINE A LIEBHAUSER MD LLC
Entity Type:Organization
Organization Name:CATHERINE A LIEBHAUSER MD LLC
Other - Org Name:CATHERINE A LIEBHAUSER MD LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIEBHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-746-7712
Mailing Address - Street 1:10 CRESTMONT RD APT 6R
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-1936
Mailing Address - Country:US
Mailing Address - Phone:973-746-7712
Mailing Address - Fax:201-462-3847
Practice Address - Street 1:24 PORTLAND PL
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2822
Practice Address - Country:US
Practice Address - Phone:973-746-7712
Practice Address - Fax:201-462-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA567602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ721369Medicare UPIN