Provider Demographics
NPI:1609924893
Name:LIEBLING, MADELINE (LMFT,MA)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:LIEBLING
Suffix:
Gender:F
Credentials:LMFT,MA
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 484
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01096-0484
Mailing Address - Country:US
Mailing Address - Phone:413-628-4011
Mailing Address - Fax:
Practice Address - Street 1:215 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-9622
Practice Address - Country:US
Practice Address - Phone:413-774-1000
Practice Address - Fax:413-774-1197
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1290106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1584OtherLICENSE