Healthcare Provider Details

I. General information

NPI: 1720298649
Provider Name (Legal Business Name): CAROLE ILENE LIEBERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S BEVERLY DR # 108
BEVERLY HILLS CA
90212-3800
US

IV. Provider business mailing address

30765 PACIFIC COAST HWY # 367
MALIBU CA
90265-3646
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-5433
  • Fax: 310-457-5335
Mailing address:
  • Phone: 310-457-5441
  • Fax: 310-457-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA34122
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number128409-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberA34122
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number128409-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA34122
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number128409-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: