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NPI Code Detail

MEDICARE: SHERALYN LIEBERG

MEDICARE: SHERALYN LIEBERG
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
1101YA0400XAddiction (Substance Use Disorder) CounselorA063481123CA

General Provider Information

NPI Number : 1912540360
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHERALYN LIEBERG
Provider Business Mailing Address
First Line : 270 W 14TH ST
Second Line :
City : SAN PEDRO
State : CA
Zip : 90731-4396
Country : US
Telephone Number : 310-519-8723
Fax Number :
Provider Business Practice Location Address
First Line : 270 W 14TH ST
Second Line :
City : SAN PEDRO
State : CA
Zip : 90731-4396
Country : US
Telephone Number : 310-519-8723
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2019
Last Update Date : 11/28/2023

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Directions to “ SHERALYN LIEBERG ” Practice Location

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