Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003132622 |
---|---|
Provider Name | Andrew Liberman |
First Address | Santa Monica, CA 90401-1122 |
Second Address | Santa Monica, CA 90401-1122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2010 |
Last Update Date | 08/04/2010 |