Provider Demographics
NPI:1639270424
Name:LIEBENSON-MORSE, PATRICIA CAROL (LICSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:CAROL
Last Name:LIEBENSON-MORSE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:TRISH
Other - Middle Name:CAROL
Other - Last Name:LIEBENSON-MORSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:267 OLD STREET RD
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458
Mailing Address - Country:US
Mailing Address - Phone:603-924-2366
Mailing Address - Fax:
Practice Address - Street 1:133 GROVE ST
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1755
Practice Address - Country:US
Practice Address - Phone:603-924-9100
Practice Address - Fax:603-924-9102
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHSW8821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30422837Medicaid
NHLIRE5983Medicare ID - Type Unspecified