Healthcare Provider Details

I. General information

NPI: 1598581506
Provider Name (Legal Business Name): DAVID MICHAEL LIEBERMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N 49TH ST
PHILADELPHIA PA
19139-2718
US

IV. Provider business mailing address

2121 MOUNT VERNON ST APT 3R
PHILADELPHIA PA
19130-3100
US

V. Phone/Fax

Practice location:
  • Phone: 215-471-2042
  • Fax:
Mailing address:
  • Phone: 267-318-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW023893
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: