Provider Demographics
NPI:1184883068
Name:LIBERMAN, MAXINE S (PHD)
Entity type:Individual
Prefix:DR
First Name:MAXINE
Middle Name:S
Last Name:LIBERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 WINTHROP SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1148
Mailing Address - Country:US
Mailing Address - Phone:617-846-0094
Mailing Address - Fax:617-846-0094
Practice Address - Street 1:238 WINTHROP SHORE DR
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-1148
Practice Address - Country:US
Practice Address - Phone:617-846-0094
Practice Address - Fax:617-846-0094
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4752103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical