Provider Demographics
NPI:1871940395
Name:LIEBMAN, MATTHEW GRANT (PSYD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GRANT
Last Name:LIEBMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5650
Mailing Address - Country:US
Mailing Address - Phone:908-757-1399
Mailing Address - Fax:
Practice Address - Street 1:5 MOUNTAIN BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5650
Practice Address - Country:US
Practice Address - Phone:908-757-1399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5803103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty