Provider Demographics
NPI:1962689703
Name:LIBUTTI, JENNIFER ANN (LAC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:LIBUTTI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:GIBBONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:128 HIGH MEADOW DRIVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337
Mailing Address - Country:US
Mailing Address - Phone:917-605-1226
Mailing Address - Fax:212-764-1170
Practice Address - Street 1:128 HIGH MEADOW DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-4003
Practice Address - Country:US
Practice Address - Phone:646-801-6810
Practice Address - Fax:718-764-1170
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000319171100000X
NY25 003745171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist