Provider Demographics
NPI:1871827154
Name:LEIBOWITZ, GEORGE STUART (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:STUART
Last Name:LEIBOWITZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 HEDGEROW DR
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6879
Mailing Address - Country:US
Mailing Address - Phone:802-881-3276
Mailing Address - Fax:
Practice Address - Street 1:25 WENTWORTH DR
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-9733
Practice Address - Country:US
Practice Address - Phone:802-878-4990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-19
Last Update Date:2009-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900012141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical