Provider Demographics
NPI:1457304115
Name:LIEBOWITZ, ERROL E (PHD)
Entity Type:Individual
Prefix:
First Name:ERROL
Middle Name:E
Last Name:LIEBOWITZ
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 1:780 LYNNHAVEN PKWY
Mailing Address - Street 2:SUITE 340
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7332
Mailing Address - Country:US
Mailing Address - Phone:757-498-9585
Mailing Address - Fax:757-468-1685
Practice Address - Street 1:780 LYNNHAVEN PKWY
Practice Address - Street 2:SUITE 340
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7332
Practice Address - Country:US
Practice Address - Phone:757-498-9585
Practice Address - Fax:757-468-1685
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001135103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7706201Medicaid
VA680000851Medicare ID - Type Unspecified