Provider Demographics
NPI:1215331392
Name:LIBURD, JANNETT (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JANNETT
Middle Name:
Last Name:LIBURD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 PLEASANT ST
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-2571
Mailing Address - Country:US
Mailing Address - Phone:781-344-3400
Mailing Address - Fax:781-344-3401
Practice Address - Street 1:294 PLEASANT ST
Practice Address - Street 2:SUITE 202A
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-2571
Practice Address - Country:US
Practice Address - Phone:781-344-3400
Practice Address - Fax:781-344-3401
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213131101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor