Provider Demographics
NPI:1891075297
Name:LIEBER, ANNA CONSTANCE (MS)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:CONSTANCE
Last Name:LIEBER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 HODGES BLVD APT 1518
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-3050
Mailing Address - Country:US
Mailing Address - Phone:801-556-1202
Mailing Address - Fax:904-805-9925
Practice Address - Street 1:6780 PATANIA WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5798
Practice Address - Country:US
Practice Address - Phone:904-805-0850
Practice Address - Fax:904-805-9925
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11498101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health