Provider Demographics
NPI:1558424630
Name:LIEBHOBER, ROSALYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSALYN
Middle Name:
Last Name:LIEBHOBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROSALYN
Other - Middle Name:
Other - Last Name:LIEBHOBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:9 ROBINSON TERRACE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3917
Mailing Address - Country:US
Mailing Address - Phone:973-471-9692
Mailing Address - Fax:973-471-9692
Practice Address - Street 1:9 ROBINSON TERRACE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3917
Practice Address - Country:US
Practice Address - Phone:973-471-9692
Practice Address - Fax:973-471-9692
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001537001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLI835504Medicare ID - Type Unspecified