Provider Demographics
NPI:1326120072
Name:LIBERTY HEALTH GROUP PC
Entity Type:Organization
Organization Name:LIBERTY HEALTH GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUOME
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:215-750-5525
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:BUCKINGHAM
Mailing Address - State:PA
Mailing Address - Zip Code:18912-0215
Mailing Address - Country:US
Mailing Address - Phone:215-750-5525
Mailing Address - Fax:215-750-5538
Practice Address - Street 1:670 WOODBOURNE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-750-5525
Practice Address - Fax:215-750-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0102287000OtherINDEPENDENCE BLUE CROSS
0102287000OtherKEYSTONE HEALTH PLAN EAST
0102287000OtherINDEPENDENCE BLUE CROSS
PA034252Medicare ID - Type Unspecified