1639270424 NPI number — MS. PATRICIA CAROL LIEBENSON-MORSE LICSW

Table of content: MS. PATRICIA CAROL LIEBENSON-MORSE LICSW (NPI 1639270424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639270424 NPI number — MS. PATRICIA CAROL LIEBENSON-MORSE LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIEBENSON-MORSE
Provider First Name:
PATRICIA
Provider Middle Name:
CAROL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIEBENSON-MORSE
Provider Other First Name:
TRISH
Provider Other Middle Name:
CAROL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1639270424
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
267 OLD STREET RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PETERBOROUGH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-924-2366
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 GROVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PETERBOROUGH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03458-1755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-924-9100
Provider Business Practice Location Address Fax Number:
603-924-9102
Provider Enumeration Date:
09/26/2006

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:  SW882 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30422837 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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