Healthcare Provider Details

I. General information

NPI: 1801913587
Provider Name (Legal Business Name): JOAN VERA LIEBERMANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 29TH PL NW
WASHINGTON DC
20008-2106
US

IV. Provider business mailing address

4611 29TH PL NW
WASHINGTON DC
20008-2106
US

V. Phone/Fax

Practice location:
  • Phone: 202-966-0252
  • Fax: 202-362-5532
Mailing address:
  • Phone: 202-966-0252
  • Fax: 202-362-5532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number17384
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: