Healthcare Provider Details

I. General information

NPI: 1457304115
Provider Name (Legal Business Name): ERROL E LIEBOWITZ PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 LYNNHAVEN PKWY SUITE 340
VIRGINIA BEACH VA
23452-7332
US

IV. Provider business mailing address

780 LYNNHAVEN PKWY SUITE 340
VIRGINIA BEACH VA
23452-7332
US

V. Phone/Fax

Practice location:
  • Phone: 757-498-9585
  • Fax: 757-468-1685
Mailing address:
  • Phone: 757-498-9585
  • Fax: 757-468-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810001135
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: