NPIMap

Organization Active NPI

Liberation-Based Therapy LCSW PLLC

  • Clinical Social Worker
  • Brooklyn, NY
National Provider Identifier
1255926176
Registry record updated Mar 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
LIBERATION-BASED THERAPY LCSW PLLC
Practice address
590 Flatbush Avenue #14S
Brooklyn, NY 11225-4994
Phone
(347) 525-2272
NPI assigned
Mar 2, 2021
Last updated
Mar 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tanisha Christie, LCSWNPI 1356901847
Title
Owner
Phone
(347) 525-2272

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

590 Flatbush Avenue #14S
Brooklyn, NY 11225-4994

Mailing address

590 Flatbush Ave #14S
Brooklyn, NY 11225-4994
Phone (347) 525-2272

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230824002687 NY Part B Supplier - Clinic/Group Practice 7618330598 Receives reassigned benefits from 4 practitioners
Practice locations: New York, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614643200000",
    "number": "1255926176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 FLATBUSH AVE #14S",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112254994",
            "telephone_number": "347-525-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 FLATBUSH AVENUE #14S",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112254994",
            "telephone_number": "347-525-2272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERATION-BASED THERAPY LCSW PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-02",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A",
        "authorized_official_last_name": "CHRISTIE",
        "authorized_official_first_name": "TANISHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "347-525-2272",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.