Provider Demographics
NPI:1669555439
Name:LIBIHOUL, FRANC JOHN (LCSW)
Entity type:Individual
Prefix:
First Name:FRANC
Middle Name:JOHN
Last Name:LIBIHOUL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4422
Mailing Address - Country:US
Mailing Address - Phone:845-331-3001
Mailing Address - Fax:845-335-4600
Practice Address - Street 1:319 BROADWAY
Practice Address - Street 2:
Practice Address - City:PORT EWEN
Practice Address - State:NY
Practice Address - Zip Code:12466
Practice Address - Country:US
Practice Address - Phone:845-339-8707
Practice Address - Fax:845-339-2610
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037837-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420795Medicaid