Provider Demographics
NPI:1144946294
Name:LIEBERMAN, DAVID (MFTC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5377 MANHATTAN CIR STE 204
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4345
Mailing Address - Country:US
Mailing Address - Phone:303-335-0430
Mailing Address - Fax:
Practice Address - Street 1:5377 MANHATTAN CIR STE 204
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4345
Practice Address - Country:US
Practice Address - Phone:303-335-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014351106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist