Provider Demographics
NPI:1639598071
Name:LIEBERENZ, DIA (LCPC)
Entity Type:Individual
Prefix:
First Name:DIA
Middle Name:
Last Name:LIEBERENZ
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:DIA
Other - Middle Name:
Other - Last Name:LIEBERENZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:592 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2205
Mailing Address - Country:US
Mailing Address - Phone:331-250-1586
Mailing Address - Fax:
Practice Address - Street 1:1010 JORIE BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2215
Practice Address - Country:US
Practice Address - Phone:331-250-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009005101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor