Provider Demographics
NPI:1952417461
Name:LEIBOWITZ, JANICE E (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:E
Last Name:LEIBOWITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JANICE
Other - Middle Name:E
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:833 SW 11TH AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2125
Mailing Address - Country:US
Mailing Address - Phone:503-318-8643
Mailing Address - Fax:
Practice Address - Street 1:833 SW 11TH AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2125
Practice Address - Country:US
Practice Address - Phone:503-318-8643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 9648101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health