Healthcare Provider Details

I. General information

NPI: 1770789836
Provider Name (Legal Business Name): CHERYL LIEBERMAN L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHERIE LIEBERMAN L.C.S.W.

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12304 SANTA MONICA BLVD SUITE 108
LOS ANGELES CA
90025-2551
US

IV. Provider business mailing address

1254 BERKELEY ST REAR APT
SANTA MONICA CA
90404-1610
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-5925
  • Fax:
Mailing address:
  • Phone: 310-828-5925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 23849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: