Provider Demographics
NPI:1730271552
Name:LEIBOWITZ, LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:
Last Name:LEIBOWITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 W. 12TH STREET
Mailing Address - Street 2:APT. #12E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8565
Mailing Address - Country:US
Mailing Address - Phone:212-675-3231
Mailing Address - Fax:212-675-2354
Practice Address - Street 1:80 E. 11TH STREET
Practice Address - Street 2:SUITE #629
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-675-3231
Practice Address - Fax:212-675-2354
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6676-1103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP844829OtherOXFORD HEALTH INSURANCE