Healthcare Provider Details

I. General information

NPI: 1528408655
Provider Name (Legal Business Name): MARY ANN LIEBERMAN PSY. D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 N 83RD ST
SEATTLE WA
98103-4308
US

IV. Provider business mailing address

506 N 83RD ST
SEATTLE WA
98103-4308
US

V. Phone/Fax

Practice location:
  • Phone: 206-719-2652
  • Fax:
Mailing address:
  • Phone: 206-719-2652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60309169
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: