Provider Demographics
NPI:1659716272
Name:LEIBOWITZ, LUCY R
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:R
Last Name:LEIBOWITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:R
Other - Last Name:BUCHHOLZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8821 COLUMBIA 100 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045
Mailing Address - Country:US
Mailing Address - Phone:410-794-4924
Mailing Address - Fax:667-200-5953
Practice Address - Street 1:8821 COLUMBIA 100 PARKWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:410-794-4924
Practice Address - Fax:667-200-5953
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD907042700Medicaid