Provider Demographics
NPI:1528408655
Name:LIEBERMAN, MARY ANN (PSY D)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 N 83RD ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4308
Mailing Address - Country:US
Mailing Address - Phone:206-719-2652
Mailing Address - Fax:
Practice Address - Street 1:506 N 83RD ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4308
Practice Address - Country:US
Practice Address - Phone:206-719-2652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60309169103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical