Healthcare Provider Details

I. General information

NPI: 1104985266
Provider Name (Legal Business Name): KIRA LIEBERMAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CHAPEL PL
WELLESLEY MA
02481-3130
US

IV. Provider business mailing address

11 CHAPEL PL
WELLESLEY MA
02481-3130
US

V. Phone/Fax

Practice location:
  • Phone: 617-816-6562
  • Fax: 781-235-7176
Mailing address:
  • Phone: 617-816-6562
  • Fax: 781-235-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8002
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: