| Doctor Name: | JOHN DAVID LIEBERMAN |
| NPI Number: | 1073804290 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | 002039 |
| Business Practice Address: | 415 Main St West Haven, CT - 065164296 |
| Business Phone Number: | 2039311184 |
| Business Fax Number: | 2039310063 |
| Mailing Address: | 415 Main St, WEST HAVEN |
| State: | CT |
| Postal Code: | 065164296 |
| Phone Number: | 2039311184 |
| Fax Number: | 2039310063 |
| NPI Enumeration Date: | 04/21/2011 |
| NPI Last Update Date: | 11/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 002039 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |