Provider Demographics
NPI:1124654116
Name:LIBERT, DIANE MARIE (BS, MPHIL)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:LIBERT
Suffix:
Gender:F
Credentials:BS, MPHIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 EUCLID AVE # EC10
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-4711
Mailing Address - Country:US
Mailing Address - Phone:216-445-7170
Mailing Address - Fax:
Practice Address - Street 1:9501 EUCLID AVE # EC10
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4711
Practice Address - Country:US
Practice Address - Phone:216-445-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-21
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program