Provider Demographics
NPI:1528578978
Name:LIEBERMAN, ALEX (BA)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31344 VIA COLINAS STE 108
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6797
Mailing Address - Country:US
Mailing Address - Phone:805-379-3212
Mailing Address - Fax:
Practice Address - Street 1:31344 VIA COLINAS STE 108
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-6797
Practice Address - Country:US
Practice Address - Phone:805-379-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
45-3589857OtherTHE HOLMAN GROUP