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General NPI Number Information
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NPI Number | 1124534623
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Entity Type | Organization
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Legal Business Name | JESSICA LIEBER, M.S., BCBA
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 6426 W 5TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90048-4710
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Country | US
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Telephone | 818-804-9219
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Fax |
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Provider Business Mailing Address
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Address Line | 6426 W 5TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90048-4710
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Country | US
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Telephone | 818-804-9219
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR / OWNER
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Name | JESSICA LIEBER
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Credential | M.S., BCBA
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Telephone | 323-452-9065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-09-6533
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License Number State | CA
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