Provider Demographics
NPI:1821221326
Name:LIEBICH, ERIN MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MARIE
Last Name:LIEBICH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 E SAINT CHARLES RD STE 212
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2600
Mailing Address - Country:US
Mailing Address - Phone:630-791-0118
Mailing Address - Fax:630-708-7654
Practice Address - Street 1:640 E SAINT CHARLES RD STE 212
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2600
Practice Address - Country:US
Practice Address - Phone:630-791-0118
Practice Address - Fax:630-708-7654
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008385103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical