Healthcare Provider Details

I. General information

NPI: 1174620967
Provider Name (Legal Business Name): GABRIELE LIEBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 ELM ST
MANCHESTER NH
03101-1203
US

IV. Provider business mailing address

2 WALL ST STE 300
MANCHESTER NH
03101-1518
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-4111
  • Fax:
Mailing address:
  • Phone: 603-668-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number11781
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: