Provider Demographics
NPI:1861009219
Name:HARTLE-TYRRELL, LIBBY
Entity Type:Individual
Prefix:
First Name:LIBBY
Middle Name:
Last Name:HARTLE-TYRRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 STUYVESANT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-2407
Mailing Address - Country:US
Mailing Address - Phone:347-489-0497
Mailing Address - Fax:
Practice Address - Street 1:110 E 30TH ST STE 503
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7393
Practice Address - Country:US
Practice Address - Phone:917-324-5579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109894104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker