Provider Demographics
NPI:1851550396
Name:LIEBLER, KAORI MIYAZAWA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KAORI
Middle Name:MIYAZAWA
Last Name:LIEBLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4427 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5403
Mailing Address - Country:US
Mailing Address - Phone:773-275-7212
Mailing Address - Fax:773-275-0958
Practice Address - Street 1:4427 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5403
Practice Address - Country:US
Practice Address - Phone:773-275-7212
Practice Address - Fax:773-275-0958
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0129571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical