Provider Demographics
NPI:1295892966
Name:LALIBERTE, ROBERT GERALD (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GERALD
Last Name:LALIBERTE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 N NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7431
Mailing Address - Country:US
Mailing Address - Phone:719-475-8038
Mailing Address - Fax:719-475-0993
Practice Address - Street 1:1414 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7431
Practice Address - Country:US
Practice Address - Phone:719-475-8038
Practice Address - Fax:719-475-0993
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2346103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO126598Medicaid
CO66426Medicare ID - Type Unspecified
CO126598Medicaid