Healthcare Provider Details

I. General information

NPI: 1508552357
Provider Name (Legal Business Name): CLARA ROSE LIBEROV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 NW COLLEGE WAY STE 7B
BEND OR
97703-1419
US

IV. Provider business mailing address

20818 CROSS CT
BEND OR
97701-8279
US

V. Phone/Fax

Practice location:
  • Phone: 845-826-0189
  • Fax:
Mailing address:
  • Phone: 845-826-0189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC11360
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: