Provider Demographics
NPI:1629752126
Name:LIEBMANN, GINGER (MS, LPC-IT)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:LIEBMANN
Suffix:
Gender:F
Credentials:MS, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 RAY O VAC DR STE 114
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2468
Mailing Address - Country:US
Mailing Address - Phone:608-514-1625
Mailing Address - Fax:
Practice Address - Street 1:700 RAY O VAC DR STE 114
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2468
Practice Address - Country:US
Practice Address - Phone:608-514-1625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7443-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health