Provider Demographics
NPI:1962517193
Name:LIEBLER, GENE KEVIN (LCSW)
Entity type:Individual
Prefix:MR
First Name:GENE
Middle Name:KEVIN
Last Name:LIEBLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 W DICKENS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3905
Mailing Address - Country:US
Mailing Address - Phone:773-936-0093
Mailing Address - Fax:
Practice Address - Street 1:2907 W DICKENS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3905
Practice Address - Country:US
Practice Address - Phone:773-936-0093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1636112OtherBLUE CROSS PROVIDER NUMBE