Provider Demographics
NPI:1174153936
Name:LIEBERMAN, DEVORA
Entity type:Individual
Prefix:
First Name:DEVORA
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 EXCHANGE CT FL USA
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-4048
Mailing Address - Country:US
Mailing Address - Phone:561-331-1760
Mailing Address - Fax:
Practice Address - Street 1:3015 EXCHANGE CT FL USA
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-4048
Practice Address - Country:US
Practice Address - Phone:561-245-0315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17716101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH17716OtherPRIVATE PRACTICE