Healthcare Provider Details

I. General information

NPI: 1063681666
Provider Name (Legal Business Name): PETER LIELBRIEDIS PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 IRONBOUND ROAD 8791
WILLIAMSBURG VA
23187-8791
US

IV. Provider business mailing address

102 MARCY DR
YORKTOWN VA
23693-2039
US

V. Phone/Fax

Practice location:
  • Phone: 757-253-5244
  • Fax:
Mailing address:
  • Phone: 757-599-4698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810002781
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: