Provider Demographics
NPI:1104943307
Name:LIEBERMAN, MARYANN C (RLCSW)
Entity type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:C
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:RLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:AQUEBOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11931-0667
Mailing Address - Country:US
Mailing Address - Phone:631-727-7225
Mailing Address - Fax:631-727-4034
Practice Address - Street 1:193 GRIFFING AVE
Practice Address - Street 2:ST A
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901
Practice Address - Country:US
Practice Address - Phone:631-727-7225
Practice Address - Fax:631-727-4034
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR050261-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical