Healthcare Provider Details

I. General information

NPI: 1407105109
Provider Name (Legal Business Name): CHERYL LIEBERMAN MS EDS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 VIRGINIA AVE
CLIFTON NJ
07012-1225
US

IV. Provider business mailing address

444 MADISON AVE SUITE 1800
NEW YORK NY
10022-6903
US

V. Phone/Fax

Practice location:
  • Phone: 917-974-1308
  • Fax:
Mailing address:
  • Phone: 917-974-1308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number00898
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: