Provider Demographics
NPI:1255926176
Name:LIBERATION-BASED THERAPY LCSW PLLC
Entity type:Organization
Organization Name:LIBERATION-BASED THERAPY LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:347-525-2272
Mailing Address - Street 1:590 FLATBUSH AVE #14S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4994
Mailing Address - Country:US
Mailing Address - Phone:347-525-2272
Mailing Address - Fax:
Practice Address - Street 1:590 FLATBUSH AVENUE #14S
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4994
Practice Address - Country:US
Practice Address - Phone:347-525-2272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty