Provider Demographics
NPI:1700397924
Name:LEIBOVITZ, RACHEL (MA LLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:LEIBOVITZ
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 PILGRIM AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1003
Mailing Address - Country:US
Mailing Address - Phone:248-760-5130
Mailing Address - Fax:
Practice Address - Street 1:4410 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6515
Practice Address - Country:US
Practice Address - Phone:248-549-4339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-15
Last Update Date:2017-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013017103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling