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General NPI Number Information
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NPI Number | 1902373384
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Entity Type | Individual
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Provider Name | DAVID BRUCE LIEBERMAN BA, MS, CAS
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Gender | Male
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Dates
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Enumeration Date | 10/24/2018
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 2 COUNTRY CLUB RD
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City | QUEENSBURY
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State | NY
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Zip | 12804-1702
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Country | US
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Telephone | 518-926-2050
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Fax |
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Provider Business Mailing Address
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Address Line | 44 FOX HOLLOW LN
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City | QUEENSBURY
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State | NY
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Zip | 12804-1142
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Country | US
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Telephone | 518-745-1120
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State | NY
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