Healthcare Provider Details

I. General information

NPI: 1194394619
Provider Name (Legal Business Name): STEPHANIE LIUBA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2021
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 W SHAW AVE STE 200
FRESNO CA
93704-2515
US

IV. Provider business mailing address

516 W SHAW AVE STE 200
FRESNO CA
93704-2515
US

V. Phone/Fax

Practice location:
  • Phone: 559-834-8494
  • Fax:
Mailing address:
  • Phone: 559-834-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: