Healthcare Provider Details

I. General information

NPI: 1235476375
Provider Name (Legal Business Name): BETH LIEBERMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E CHEYENNE RD STE 209
COLORADO SPRINGS CO
80906-2535
US

IV. Provider business mailing address

108 E CHEYENNE RD STE 209
COLORADO SPRINGS CO
80906-2535
US

V. Phone/Fax

Practice location:
  • Phone: 719-444-8550
  • Fax: 719-444-8551
Mailing address:
  • Phone: 719-444-8550
  • Fax: 719-444-8551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number983012
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: