Provider Demographics
NPI:1518045830
Name:LORI LIEBERMAN & ASSOCIATES LLC
Entity type:Organization
Organization Name:LORI LIEBERMAN & ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:F
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:781-335-7559
Mailing Address - Street 1:111 WILLARD ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1274
Mailing Address - Country:US
Mailing Address - Phone:781-335-7559
Mailing Address - Fax:781-331-6410
Practice Address - Street 1:111 WILLARD ST STE 2F
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1274
Practice Address - Country:US
Practice Address - Phone:781-335-7559
Practice Address - Fax:781-331-6410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA743133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA688793OtherTUFTS HEALTH
MALG0026OtherBCBS
MALG0026OtherBCBS