Provider Demographics
NPI:1770789836
Name:LIEBERMAN, CHERYL (LCSW)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHERIE
Other - Middle Name:
Other - Last Name:LIEBERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1254 BERKELEY ST
Mailing Address - Street 2:REAR APT
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1610
Mailing Address - Country:US
Mailing Address - Phone:310-828-5925
Mailing Address - Fax:
Practice Address - Street 1:12304 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2551
Practice Address - Country:US
Practice Address - Phone:310-828-5925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 238491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical