Provider Demographics
NPI:1306970835
Name:LIEBERT, VALERIE (PCC)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:LIEBERT
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1406
Mailing Address - Country:US
Mailing Address - Phone:419-309-7100
Mailing Address - Fax:419-517-8460
Practice Address - Street 1:337 W 2ND ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1406
Practice Address - Country:US
Practice Address - Phone:419-309-7100
Practice Address - Fax:419-517-8460
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-2595-S101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000115807OtherANTHEM BCBS