Provider Demographics
NPI:1265858658
Name:LIEBERMAN, ROBERT E (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 SE N ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-3905
Mailing Address - Country:US
Mailing Address - Phone:541-479-8394
Mailing Address - Fax:
Practice Address - Street 1:1590 SE N ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-3905
Practice Address - Country:US
Practice Address - Phone:541-479-8394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCO930101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional