Healthcare Provider Details

I. General information

NPI: 1164002879
Provider Name (Legal Business Name): MELANIE CHRISTINE LIEBERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2499 GLADES RD STE 109
BOCA RATON FL
33431-7260
US

IV. Provider business mailing address

3469 CARAMBOLA CIR S
COCONUT CREEK FL
33066-2126
US

V. Phone/Fax

Practice location:
  • Phone: 561-350-8592
  • Fax:
Mailing address:
  • Phone: 954-376-2420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: