Provider Demographics
NPI:1265068043
Name:LIEBERMAN, LAYNE (RDN, LDN)
Entity type:Individual
Prefix:
First Name:LAYNE
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:HELAINE
Other - Middle Name:S
Other - Last Name:LIEBELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 E PALMETTO PARK RD APT 910
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5630
Mailing Address - Country:US
Mailing Address - Phone:516-729-1006
Mailing Address - Fax:
Practice Address - Street 1:200 E PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5623
Practice Address - Country:US
Practice Address - Phone:516-729-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7781133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered