Eileen Martha Liezert, LCSW
Individual provider Active NPI Clinical Social Worker · Rockford, IL
NPI 1386007276 · NPPES record last updated Mar 30, 2016
Key facts
- NPI
- 1386007276
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149.001045 (IL)
- Practice address
- 210 N Longwood St
Rockford, IL 61107-4134 - Phone
- (815) 962-5585
- Fax
- (815) 962-8945
- NPI assigned
- Mar 30, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.001045 | IL | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.001045 | IL | Yes |
Addresses
Primary practice location
210 N Longwood St
Rockford, IL 61107-4134
Mailing address
210 N Longwood St
Rockford, IL 61107-4134
Phone (815) 962-5585
NPI Registry JSON
{
"created_epoch": "1459296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459296000000",
"number": "1386007276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 N LONGWOOD ST",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611074134",
"telephone_number": "815-962-5585",
"fax_number": "815-962-8945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 N LONGWOOD ST",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611074134",
"telephone_number": "815-962-5585",
"fax_number": "815-962-8945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIEZERT",
"first_name": "EILEEN",
"middle_name": "MARTHA",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-30",
"last_updated": "2016-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.001045",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.