Healthcare Provider Details

I. General information

NPI: 1902373384
Provider Name (Legal Business Name): DAVID BRUCE LIEBERMAN BA, MS, CAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COUNTRY CLUB RD
QUEENSBURY NY
12804-1702
US

IV. Provider business mailing address

44 FOX HOLLOW LN
QUEENSBURY NY
12804-1142
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-2050
  • Fax:
Mailing address:
  • Phone: 518-745-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: