Provider Demographics
NPI:1154868339
Name:LIEBERMAN, JENNIFER (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 BEE RIDGE RD
Mailing Address - Street 2:#306
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1054
Mailing Address - Country:US
Mailing Address - Phone:941-315-6808
Mailing Address - Fax:
Practice Address - Street 1:3665 BEE RIDGE RD
Practice Address - Street 2:#306
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1054
Practice Address - Country:US
Practice Address - Phone:941-315-6808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3244106H00000X
CA39051106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist