MEDICARE: MR. MICHAEL CHARLES LIEBERMAN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701006194	VA

General Provider Information

NPI Number	:	1558802033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL CHARLES LIEBERMAN LPC

Provider Business Mailing Address
First Line	:	3921 BLENHEIM BLVD STE 73C
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-2429
Country	:	US
Telephone Number	:	703-919-5543
Fax Number	:

Provider Business Practice Location Address
First Line	:	3921 BLENHEIM BLVD STE 73C
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-2429
Country	:	US
Telephone Number	:	703-919-5543
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2017
Last Update Date	:	10/07/2025

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