1366441214 NPI number — MRS. JILL LIEBER LCSWR

Table of content: MRS. JILL LIEBER LCSWR (NPI 1366441214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366441214 NPI number — MRS. JILL LIEBER LCSWR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIEBER
Provider First Name:
JILL
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366441214
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2430 N FOREST RD STE 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GETZVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14068-1557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-688-5372
Provider Business Mailing Address Fax Number:
716-688-5327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2430 N FOREST RD STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GETZVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14068-1557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-688-5372
Provider Business Practice Location Address Fax Number:
716-688-5327
Provider Enumeration Date:
07/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R043130-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000590012002 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00026440101 . This is a "UNIVERA HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 140936FK . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 257486 . This is a "APS HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6211738 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 535524 . This is a "VALUEOPTIONS NYS EMPIRE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 02442771 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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