Provider Demographics
NPI:1093894453
Name:LIBERMAN, ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:LIBERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1776
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92781-1776
Mailing Address - Country:US
Mailing Address - Phone:714-730-2080
Mailing Address - Fax:714-730-1627
Practice Address - Street 1:242 W MAIN ST
Practice Address - Street 2:200 D
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7723
Practice Address - Country:US
Practice Address - Phone:714-730-2080
Practice Address - Fax:714-730-1627
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical