Provider Demographics
NPI:1285795401
Name:LEIBOWITZ, ERIC DAVID (MSW)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DAVID
Last Name:LEIBOWITZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7433
Mailing Address - Country:US
Mailing Address - Phone:781-861-0887
Mailing Address - Fax:781-674-9369
Practice Address - Street 1:9 ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4802
Practice Address - Country:US
Practice Address - Phone:617-489-5576
Practice Address - Fax:617-489-9600
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1025611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALEP01460Medicare ID - Type Unspecified