Healthcare Provider Details

I. General information

NPI: 1902116379
Provider Name (Legal Business Name): ZACHARIAH DANIEL LIEBERMAN PSYD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 06/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 BEECH ST
HOLYOKE MA
01040-3968
US

IV. Provider business mailing address

PO BOX 170
WATERPORT NY
14571-0170
US

V. Phone/Fax

Practice location:
  • Phone: 413-540-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11029
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: