Provider Demographics
NPI:1164677431
Name:LIVELSBERGER, BRIAN (LCMFT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:LIVELSBERGER
Suffix:
Gender:M
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10315 JULEP AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3861
Mailing Address - Country:US
Mailing Address - Phone:301-704-9948
Mailing Address - Fax:
Practice Address - Street 1:4405 E WEST HWY STE 207
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4464
Practice Address - Country:US
Practice Address - Phone:240-452-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-29
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM356106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist