Provider Demographics
NPI:1518241264
Name:LIEBERMAN, BRIAN D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HARPST ST
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-8222
Mailing Address - Country:US
Mailing Address - Phone:707-826-3236
Mailing Address - Fax:
Practice Address - Street 1:730 BAYSIDE RD
Practice Address - Street 2:APT A
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521
Practice Address - Country:US
Practice Address - Phone:862-268-4853
Practice Address - Fax:862-268-4853
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28793103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool