Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 006027 | NY |
N | 103T00000X | Psychologist | 006027 | NY |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 006027 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 006027 | NY |
N | 103G00000X | Clinical Psychologist | 006027 | NY |
N | 103TC0700X | Clinical Psychologist | 006027 | NY |
N | 103TC1900X | Counseling Psychologist | 006027 | NY |
N | 103TF0000X | Family Psychologist | 006027 | NY |
N | 103TH0100X | Health Service | 006027 | NY |
N | 103TS0200X | School Psychologist | NY |
NPI | 1609086594 |
---|---|
Provider Name | Dr. Jon A. Lieberman |
First Address | Hampton Bays, NY 11946-3506 |
Second Address | Hampton Bays, NY 11946-3506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 26/07/2007 |