Provider Demographics
NPI:1518671791
Name:LEIBOWITZ, BENJAMIN N (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:N
Last Name:LEIBOWITZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1525
Mailing Address - Country:US
Mailing Address - Phone:973-467-9409
Mailing Address - Fax:
Practice Address - Street 1:675 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1525
Practice Address - Country:US
Practice Address - Phone:973-467-9409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00697900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical