Healthcare Provider Details

I. General information

NPI: 1427537547
Provider Name (Legal Business Name): REBECCA LIEBERMANN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9651 W 153RD ST STE 54
ORLAND PARK IL
60462-4688
US

IV. Provider business mailing address

9651 W 153RD ST STE 54
ORLAND PARK IL
60462-4688
US

V. Phone/Fax

Practice location:
  • Phone: 708-460-4840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.013360
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: