Provider Demographics
NPI:1609194208
Name:LIBRIE, MICHAEL MATTHEW (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MATTHEW
Last Name:LIBRIE
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2557
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28459-2557
Mailing Address - Country:US
Mailing Address - Phone:410-299-1233
Mailing Address - Fax:
Practice Address - Street 1:2222 N CALVERT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5813
Practice Address - Country:US
Practice Address - Phone:410-299-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD159001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0318485-00OtherMARYLAND MEDICAL ASSISTANCE PROGRAM
MD15900OtherLICENSED CERTIFIED SOCIAL WORKER-CLINICAL