Provider Demographics
NPI:1790920973
Name:LIBERMAN, GEFFEN (LISAC)
Entity Type:Individual
Prefix:
First Name:GEFFEN
Middle Name:
Last Name:LIBERMAN
Suffix:
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 W HIGHLAND ST
Mailing Address - Street 2:#222
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-7833
Mailing Address - Country:US
Mailing Address - Phone:480-297-7308
Mailing Address - Fax:
Practice Address - Street 1:1035 N MCQUEEN RD
Practice Address - Street 2:123
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-2333
Practice Address - Country:US
Practice Address - Phone:480-388-1495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10384101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)