Provider Demographics
NPI:1285805143
Name:LIEBERT, ALAN (LMFT107210)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:LIEBERT
Suffix:
Gender:M
Credentials:LMFT107210
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 SAN VICENTE BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-1806
Mailing Address - Country:US
Mailing Address - Phone:310-383-0084
Mailing Address - Fax:
Practice Address - Street 1:605 SAN VICENTE BLVD APT 203
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-1806
Practice Address - Country:US
Practice Address - Phone:310-383-0084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT107210106H00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist