Provider Demographics
NPI:1801945811
Name:LIEBERKNECHT, REBECCA SUSAN (PSYCHOLOGICAL ASSIST)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUSAN
Last Name:LIEBERKNECHT
Suffix:
Gender:F
Credentials:PSYCHOLOGICAL ASSIST
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:LIEBERKNECHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CLINICAL TRAINEE
Mailing Address - Street 1:3075 ADELINE ST.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703
Mailing Address - Country:US
Mailing Address - Phone:510-848-1112
Mailing Address - Fax:
Practice Address - Street 1:3075 ADELINE ST.
Practice Address - Street 2:SUITE 120
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703
Practice Address - Country:US
Practice Address - Phone:510-848-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB35555101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health