Provider Demographics
NPI:1053531533
Name:LIBERMAN, REENA (MS)
Entity type:Individual
Prefix:MS
First Name:REENA
Middle Name:
Last Name:LIBERMAN
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 1:914 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3508
Mailing Address - Country:US
Mailing Address - Phone:734-668-7424
Mailing Address - Fax:
Practice Address - Street 1:1207 PACKARD ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3810
Practice Address - Country:US
Practice Address - Phone:734-741-1655
Practice Address - Fax:734-761-6440
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008420103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical