Provider Demographics
NPI:1093738627
Name:LIEBERMAN, LISA A (MSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15100 BOONES FERRY RD
Mailing Address - Street 2:SUITE 750A
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3469
Mailing Address - Country:US
Mailing Address - Phone:503-697-5956
Mailing Address - Fax:503-635-9127
Practice Address - Street 1:15100 BOONES FERRY RD
Practice Address - Street 2:SUITE 750A
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3469
Practice Address - Country:US
Practice Address - Phone:503-697-5956
Practice Address - Fax:503-635-9127
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLCSW14731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000TLBLBMedicare UPIN