Individual provider Active NPI

Nicole Lieberman

  • Clinical Social Worker
  • Woodside, NY
National Provider Identifier
1568093516
Registry record updated Feb 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
101876 Issued in NY
Practice address
4277 65TH PL
Woodside, NY 11377-5054
Phone
(718) 429-2000
NPI assigned
Jan 29, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 108965 NY
Clinical Social Worker 1041C0700X 101876 NY Primary

Addresses

Primary practice location

4277 65TH PL
Woodside, NY 11377-5054

Mailing address

205 E 85TH St Apt 5Q
New York, NY 10028-3222
Phone (646) 385-3316

Other practice location 1

3635 Bell Blvd Ste 203
Bayside, NY 11361-2097
Phone (718) 504-9256 ext. 49256

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
108965NYMDSocial Worker
101876NYMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1580256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770681600000",
    "number": "1568093516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 E 85TH ST APT 5Q",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100283222",
            "telephone_number": "646-385-3316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4277 65TH PL",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113775054",
            "telephone_number": "718-429-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3635 Bell Blvd Ste 203",
            "address_purpose": "LOCATION",
            "city": "Bayside",
            "state": "NY",
            "postal_code": "113612097",
            "country_code": "US",
            "telephone_number": "718-504-9256 x49256",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIEBERMAN",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-29",
        "last_updated": "2026-02-10",
        "certification_date": "2026-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "108965",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "101876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodside, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.