Healthcare Provider Details

I. General information

NPI: 1497058101
Provider Name (Legal Business Name): CLAIRE GERTRUDE LIEBERMAN RD,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CLAIRE GERTRUDE LIEBERMAN MSW

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7812 LAKE CITY WAY NE
SEATTLE WA
98115-4358
US

IV. Provider business mailing address

7812 LAKE CITY WAY NE
SEATTLE WA
98115-4358
US

V. Phone/Fax

Practice location:
  • Phone: 206-949-0524
  • Fax:
Mailing address:
  • Phone: 206-949-0524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00006506
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI 00001799
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: