Healthcare Provider Details

I. General information

NPI: 1295056091
Provider Name (Legal Business Name): BENJAMIN PAUL LIEBERMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 01/21/2025
Certification Date: 12/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 SAWTELLE BLVD STE 610
LOS ANGELES CA
90025-7013
US

IV. Provider business mailing address

1849 SAWTELLE BLVD STE 610
LOS ANGELES CA
90025-7013
US

V. Phone/Fax

Practice location:
  • Phone: 310-871-4924
  • Fax:
Mailing address:
  • Phone: 310-871-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number81088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: