Provider Demographics
NPI:1770171530
Name:KATELYN LIEB ND LLC
Entity type:Organization
Organization Name:KATELYN LIEB ND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LIEB
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:845-238-1335
Mailing Address - Street 1:229 BRANFORD RD UNIT 412
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-1316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47 OAK ST STE 290
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5320
Practice Address - Country:US
Practice Address - Phone:203-703-9033
Practice Address - Fax:475-268-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1013519719OtherOTHER