Provider Demographics
NPI:1942907373
Name:LIEBERMAN, BLAIR (MSW)
Entity Type:Individual
Prefix:MS
First Name:BLAIR
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WINTHROP ST APT X5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-6068
Mailing Address - Country:US
Mailing Address - Phone:602-326-7356
Mailing Address - Fax:
Practice Address - Street 1:80 WINTHROP ST APT X5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-6068
Practice Address - Country:US
Practice Address - Phone:602-326-7356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0903901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical