Healthcare Provider Details

I. General information

NPI: 1851171565
Provider Name (Legal Business Name): ERICA LIEBMAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 09/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 WALNUT ST STE 1414
PHILADELPHIA PA
19102-3610
US

IV. Provider business mailing address

2100 WALNUT ST APT 13G
PHILADELPHIA PA
19103-4893
US

V. Phone/Fax

Practice location:
  • Phone: 610-256-4768
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS019953
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: