Provider Demographics
NPI:1265301121
Name:LIEBERMAN, CAMDEN JAYE
Entity type:Individual
Prefix:
First Name:CAMDEN
Middle Name:JAYE
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 MADRONE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9578
Mailing Address - Country:US
Mailing Address - Phone:480-313-6777
Mailing Address - Fax:773-496-7141
Practice Address - Street 1:6820 MADRONE DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9578
Practice Address - Country:US
Practice Address - Phone:480-313-6777
Practice Address - Fax:773-496-7141
Is Sole Proprietor?:No
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist