Healthcare Provider Details

I. General information

NPI: 1801199542
Provider Name (Legal Business Name): ROBERT LOUIS LIEBERMAN LISW-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 NORTHFIELD ROAD
HIGHLAND HEIGHTS OH
44128-2811
US

IV. Provider business mailing address

4255 NORTHFIELD ROAD
HIGHLAND HEIGHTS OH
44128-2811
US

V. Phone/Fax

Practice location:
  • Phone: 216-292-9700
  • Fax:
Mailing address:
  • Phone: 216-292-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0009955-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: