Provider Demographics
NPI:1275713398
Name:LIEBERT, DAVID T (EDD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:LIEBERT
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S FIELDING AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2224
Mailing Address - Country:US
Mailing Address - Phone:813-546-1628
Mailing Address - Fax:
Practice Address - Street 1:309 S FIELDING AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2224
Practice Address - Country:US
Practice Address - Phone:813-546-1628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5966101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional