Provider Demographics
NPI:1578766705
Name:LIEBERMAN, LAWRENCE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
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 1:3930 RICHMOND AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5100
Mailing Address - Country:US
Mailing Address - Phone:917-579-9072
Mailing Address - Fax:718-966-4822
Practice Address - Street 1:131 SEIDMAN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5527
Practice Address - Country:US
Practice Address - Phone:718-966-4822
Practice Address - Fax:718-966-4822
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP024867-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical