Individual provider Active NPI

Dominika Lieberman

  • Clinical Social Worker
  • Teaneck, NJ
National Provider Identifier
1336812734
Registry record updated Jul 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC06008200 Issued in NJ
Practice address
718 Teaneck Rd
Teaneck, NJ 07666-4245
Phone
(201) 833-3000
NPI assigned
Jul 30, 2021
Last updated
Jul 30, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 44SC06008200 NJ Primary

Addresses

Primary practice location

718 Teaneck Rd
Teaneck, NJ 07666-4245

Mailing address

3 University PLZ Ste 205
Hackensack, NJ 07601-6208
Phone (201) 833-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210809002321 NJ Practitioner - Clinical Social Worker 2365846649 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Holy Name Primary Care and Specialty Associates PCGroup PAC ID 4082847447, 44 clinicians

Practice addresses (Care Compare)

718 Teaneck Rd
Teaneck, NJ 07666-4245
Phone (201) 833-3000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
44SC06008200NJMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Holy Name Primary Care and Specialty Associates, PC CurrentSince Aug 1, 2021 Accepting new patients
Pause Counseling CurrentSince Jun 30, 2024 Accepting new patients

Locations

3 University Plz
Ste 205
Hackensack, NJ 07601

185 Cedar Ln
Teaneck, NJ 07666
Phone (201) 836-0888

718 Teaneck Rd
Teaneck, NJ 07666
Phone (201) 833-3232

354 Old Hook Rd
Ste 102
Westwood, NJ 07675
Phone (201) 358-0400

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1627603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627603200000",
    "number": "1336812734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 UNIVERSITY PLZ STE 205",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076016208",
            "telephone_number": "201-833-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "718 TEANECK RD",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664245",
            "telephone_number": "201-833-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBERMAN",
        "first_name": "DOMINIKA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-30",
        "last_updated": "2021-07-30",
        "certification_date": "2021-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC06008200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Teaneck, NJ

Sources for this page

Verify at the official NPI Registry.