Provider Demographics
NPI:1932147576
Name:LIERMAN, DIANE CAROLE (MFT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:CAROLE
Last Name:LIERMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:CAROLE
Other - Last Name:BEATTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:203 AIOKOA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1668
Mailing Address - Country:US
Mailing Address - Phone:808-753-4963
Mailing Address - Fax:808-254-5054
Practice Address - Street 1:203 AIOKOA ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1668
Practice Address - Country:US
Practice Address - Phone:808-753-4963
Practice Address - Fax:808-254-5054
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT 37106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI222307OtherHMA INC
HI245514OtherHMSA