Provider Demographics
NPI:1245823715
Name:LIEB, ALIX Y
Entity type:Individual
Prefix:MS
First Name:ALIX
Middle Name:Y
Last Name:LIEB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:SHENOROCK
Mailing Address - State:NY
Mailing Address - Zip Code:10587-0345
Mailing Address - Country:US
Mailing Address - Phone:914-486-3777
Mailing Address - Fax:
Practice Address - Street 1:155 MAIN ST
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-1521
Practice Address - Country:US
Practice Address - Phone:914-279-6999
Practice Address - Fax:914-279-0908
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101752104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101752OtherOFFICE OF THE PROFESSIONS