Provider Demographics
NPI:1720270002
Name:LIBMAN, LETITIA P (MS,PHD)
Entity type:Individual
Prefix:DR
First Name:LETITIA
Middle Name:P
Last Name:LIBMAN
Suffix:
Gender:F
Credentials:MS,PHD
Other - Prefix:DR
Other - First Name:LAETITIA
Other - Middle Name:P
Other - Last Name:LIEBMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,PHD
Mailing Address - Street 1:2401 KANEVILLE RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2579
Mailing Address - Country:US
Mailing Address - Phone:630-208-7735
Mailing Address - Fax:630-208-6956
Practice Address - Street 1:741 DEARBORN ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6218
Practice Address - Country:US
Practice Address - Phone:319-351-7751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical