Provider Demographics
NPI:1386948313
Name:LIBERTY RESOURCES, INC.
Entity type:Organization
Organization Name:LIBERTY RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:VENDETTI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:315-598-4642
Mailing Address - Street 1:1850 COUNTY ROUTE 57
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-4908
Mailing Address - Country:US
Mailing Address - Phone:315-598-4642
Mailing Address - Fax:315-592-7978
Practice Address - Street 1:1850 COUNTY ROUTE 57
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-4908
Practice Address - Country:US
Practice Address - Phone:315-598-4642
Practice Address - Fax:315-592-7978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081146-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health