Provider Demographics
NPI:1740699537
Name:LIEBERMAN, RONALD (LCSW)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9346 HOBART CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-2139
Mailing Address - Country:US
Mailing Address - Phone:703-209-1382
Mailing Address - Fax:
Practice Address - Street 1:8500 EXECUTIVE PARK AVE
Practice Address - Street 2:204
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2225
Practice Address - Country:US
Practice Address - Phone:703-876-8480
Practice Address - Fax:703-876-8482
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040013281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical