Healthcare Provider Details

I. General information

NPI: 1174153936
Provider Name (Legal Business Name): DEVORA LIEBERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 EXCHANGE CT FL USA
WEST PALM BEACH FL
33409-4048
US

IV. Provider business mailing address

3015 EXCHANGE CT FL USA
WEST PALM BEACH FL
33409-4048
US

V. Phone/Fax

Practice location:
  • Phone: 561-245-0315
  • Fax:
Mailing address:
  • Phone: 561-331-1760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: