Provider Demographics
NPI:1508573502
Name:LIBERATE THE BLOCK
Entity Type:Organization
Organization Name:LIBERATE THE BLOCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:LEI
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:412-437-8687
Mailing Address - Street 1:1329 MILTON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1234
Mailing Address - Country:US
Mailing Address - Phone:412-437-8687
Mailing Address - Fax:
Practice Address - Street 1:1329 MILTON ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1234
Practice Address - Country:US
Practice Address - Phone:412-437-8687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health