Healthcare Provider Details

I. General information

NPI: 1407884968
Provider Name (Legal Business Name): LYNN I LIEBERMAN PH D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8629 BLUEJACKET ST SUITE 100
LENEXA KS
66214-1604
US

IV. Provider business mailing address

8629 BLUEJACKET ST SUITE 100
LENEXA KS
66214-1604
US

V. Phone/Fax

Practice location:
  • Phone: 913-677-3553
  • Fax: 913-677-3282
Mailing address:
  • Phone: 913-677-3553
  • Fax: 913-677-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number831
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberR0292
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: