Provider Demographics
NPI:1609961366
Name:LIBBY, SHELDON S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SHELDON
Middle Name:S
Last Name:LIBBY
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 1:385 TERHUNE AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-2448
Mailing Address - Country:US
Mailing Address - Phone:973-777-7915
Mailing Address - Fax:973-777-2226
Practice Address - Street 1:385 TERHUNE AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-2448
Practice Address - Country:US
Practice Address - Phone:973-777-7915
Practice Address - Fax:973-777-2226
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035020-1104100000X
NJ44SC014329001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
855538Medicare ID - Type Unspecified