Provider Demographics
NPI:1871686543
Name:LIEBERMAN, SAUL NEIL (PHD)
Entity Type:Individual
Prefix:
First Name:SAUL
Middle Name:NEIL
Last Name:LIEBERMAN
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 1:9225 LONGBRANCH PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901
Mailing Address - Country:US
Mailing Address - Phone:301-439-7507
Mailing Address - Fax:
Practice Address - Street 1:10630 LITTLE PATUXENT PKWY
Practice Address - Street 2:STE 212
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3264
Practice Address - Country:US
Practice Address - Phone:410-740-0333
Practice Address - Fax:410-740-0332
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01696103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD45614OtherMDIPA - COLUMBIA
MD40157202OtherCAREFIRST MD - COLUMBIA
MD35614OtherMAMSI ID
MD36140002OtherCAREFIRST BC - COLUMBIA
MD36230001OtherCAREFIRST DC PLAN
MDMD44Medicare ID - Type UnspecifiedMEDICARE - COLUMBIA