Provider Demographics
NPI:1497058101
Name:LIEBERMAN, CLAIRE GERTRUDE (RD,)
Entity Type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:GERTRUDE
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:RD,
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:GERTRUDE
Other - Last Name:LIEBERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:7812 LAKE CITY WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4358
Mailing Address - Country:US
Mailing Address - Phone:206-949-0524
Mailing Address - Fax:
Practice Address - Street 1:7812 LAKE CITY WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4358
Practice Address - Country:US
Practice Address - Phone:206-949-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000065061041C0700X
174H00000X
WADI 00001799133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174H00000XOther Service ProvidersHealth Educator