MEDICARE: ROBIN E LIEBERMAN MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	OR#1788	OR

General Provider Information

NPI Number	:	1528226701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN E LIEBERMAN MSW, LCSW

Provider Business Mailing Address
First Line	:	1020 SW TAYLOR ST STE 435
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2509
Country	:	US
Telephone Number	:	503-222-1192
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 SW TAYLOR ST STE 435
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2509
Country	:	US
Telephone Number	:	503-222-1192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2008
Last Update Date	:	05/24/2008

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