Provider Demographics
NPI:1225640204
Name:GOLIBERSUCH, ANDREW (LMHC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:GOLIBERSUCH
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CENTER CT STE 1B
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3503
Mailing Address - Country:US
Mailing Address - Phone:413-376-8002
Mailing Address - Fax:
Practice Address - Street 1:19 CENTER CT STE 1B
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3503
Practice Address - Country:US
Practice Address - Phone:413-376-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
21-446221700000X
MALMHC10001098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
21-446OtherART THERAPY CREDENTIALS BOARD
MALMHC10001098OtherBOARD OF ALLIED MENTAL HEALTH AND HUMAN SERVICES PROFESSIONS
BC-TMH-3909OtherNATIONAL BOARD OF CERTIFIED COUNSELORS