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General NPI Number Information
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NPI Number | 1598221293
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Entity Type | Individual
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Provider Name | DAVID LIEBERSON MA
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Gender | Male
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Dates
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Enumeration Date | 02/18/2019
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 10863 BOYETTE RD
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City | RIVERVIEW
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State | FL
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Zip | 33569-8012
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Country | US
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Telephone | 813-531-9433
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Fax |
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Provider Business Mailing Address
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Address Line | 4422 E COLUMBUS DR
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City | TAMPA
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State | FL
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Zip | 33605-3233
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Country | US
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Telephone | 813-384-4022
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH18026
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License Number State | FL
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