Provider Demographics
NPI:1962713966
Name:LIEBESNY, KATHERINE VALERIE (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:VALERIE
Last Name:LIEBESNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2017 JEFFERSON ST SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2419
Mailing Address - Country:US
Mailing Address - Phone:540-981-8960
Mailing Address - Fax:540-853-0511
Practice Address - Street 1:2017 JEFFERSON ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2419
Practice Address - Country:US
Practice Address - Phone:540-981-8960
Practice Address - Fax:540-853-0511
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP020522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry