Provider Demographics
NPI:1790469757
Name:LIEBERMAN, LAURIE LAURRAINE (PEER SUPPORT SPECIAL)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:LAURRAINE
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 D ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3801
Mailing Address - Country:US
Mailing Address - Phone:707-328-5594
Mailing Address - Fax:
Practice Address - Street 1:527 D ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3801
Practice Address - Country:US
Practice Address - Phone:707-328-5594
Practice Address - Fax:707-328-5594
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 175T00000X
CA373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist