Provider Demographics
NPI:1659565638
Name:LIEBMAN, MARYJANE I (PSYD)
Entity Type:Individual
Prefix:
First Name:MARYJANE
Middle Name:I
Last Name:LIEBMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 RIVERSIDE DR
Mailing Address - Street 2:7A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-9010
Mailing Address - Country:US
Mailing Address - Phone:212-662-5504
Mailing Address - Fax:
Practice Address - Street 1:280 RIVERSIDE DR
Practice Address - Street 2:7A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-9010
Practice Address - Country:US
Practice Address - Phone:212-662-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0084271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP771337OtherOXFORD
NYV956L1OtherEMPIRE BC/BS
NYV956L1OtherEMPIRE BC/BS