Provider Demographics
NPI:1841780871
Name:LIBBY, EMILY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:LIBBY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:POEHLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3738 VICTOR AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1533
Mailing Address - Country:US
Mailing Address - Phone:314-401-6898
Mailing Address - Fax:
Practice Address - Street 1:3738 VICTOR AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-1533
Practice Address - Country:US
Practice Address - Phone:314-401-6898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080225471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical