Provider Demographics
NPI:1588057335
Name:LIEBERMAN, ALLISON
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7084 BERGAMOT AVE
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-5064
Mailing Address - Country:US
Mailing Address - Phone:805-917-6860
Mailing Address - Fax:805-917-6861
Practice Address - Street 1:107 N REINO RD # 1037
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3710
Practice Address - Country:US
Practice Address - Phone:805-917-6860
Practice Address - Fax:805-917-6861
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100073106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist