Healthcare Provider Details

I. General information

NPI: 1831108117
Provider Name (Legal Business Name): BARRY S. LIEBERMAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7862 WOODROW WILSON DR
LOS ANGELES CA
90046-1256
US

IV. Provider business mailing address

7862 WOODROW WILSON DR
LOS ANGELES CA
90046-1256
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-2284
  • Fax:
Mailing address:
  • Phone: 310-274-2284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA22616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: