Provider Demographics
NPI:1659924165
Name:GOLDBERG, LIEBE DEBORAH
Entity Type:Individual
Prefix:
First Name:LIEBE
Middle Name:DEBORAH
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:MELMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:909 ORDWAY ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2115
Mailing Address - Country:US
Mailing Address - Phone:510-525-4118
Mailing Address - Fax:
Practice Address - Street 1:909 ORDWAY ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2115
Practice Address - Country:US
Practice Address - Phone:510-525-4118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10008103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical