Basic Information
| Provider Information | |||||||||
| NPI: | 1659747798 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STACY MARIE DILIBERTO | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6744 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701746744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043097844 | ||||||||
| FaxNumber: | 5043097845 | ||||||||
| Practice Location | |||||||||
| Address1: | 3196 TERRACE AVE. | ||||||||
| Address2: | |||||||||
| City: | SLIDELL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9857887822 | ||||||||
| FaxNumber: | 5043097845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2015 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | DILIBERTO | ||||||||
| AuthorizedOfficialFirstName: | STACY | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | LCSW/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5049857822 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 9492 | LA | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.