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General NPI Number Information
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NPI Number | 1669014429
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Entity Type | Organization
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Legal Business Name | COAST FAMILY PSYCHOLOGICAL SERVICES INC.
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Dates
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Enumeration Date | 10/14/2019
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Last Update Date | 10/14/2019
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Provider Practice Location Address
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Address Line | 12304 SANTA MONICA BLVD STE 203
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City | LOS ANGELES
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State | CA
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Zip | 90025-2551
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Country | US
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Telephone | 805-507-7049
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Fax | 805-257-0517
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Provider Business Mailing Address
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Address Line | 12304 SANTA MONICA BLVD STE 203
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City | LOS ANGELES
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State | CA
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Zip | 90025-2551
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Country | US
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Telephone | 805-507-7049
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Fax | 805-257-0517
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. DANA E LIEBERMAN
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Credential | PSYD
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Telephone | 805-507-7049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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