Provider Demographics
NPI:1518688571
Name:LIBERA, TAYLOR (LCSW)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:LIBERA
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-5408
Mailing Address - Country:US
Mailing Address - Phone:860-410-2228
Mailing Address - Fax:
Practice Address - Street 1:855 LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-5408
Practice Address - Country:US
Practice Address - Phone:860-410-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTVKW005M90262OtherANTHEM