Provider Demographics
NPI:1427196559
Name:LIEB, ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:LIEB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 BOVET RD
Mailing Address - Street 2:SUITE 540
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3116
Mailing Address - Country:US
Mailing Address - Phone:650-341-9011
Mailing Address - Fax:
Practice Address - Street 1:177 BOVET RD
Practice Address - Street 2:SUITE 540
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3116
Practice Address - Country:US
Practice Address - Phone:650-341-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10356103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical