Provider Demographics
NPI:1700029014
Name:LIEBMAN, SAMUEL (PHD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:LIEBMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 KEY AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3821
Mailing Address - Country:US
Mailing Address - Phone:410-367-5260
Mailing Address - Fax:410-298-8225
Practice Address - Street 1:1205 YORK RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-6210
Practice Address - Country:US
Practice Address - Phone:410-828-6062
Practice Address - Fax:410-298-8225
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04087103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist