EVAN FREDRICK LIEBERMAN (NPI# 1245781608) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245781608 |
| Entity Type | Individual |
| Full Name | EVAN FREDRICK LIEBERMAN |
| Credential | LADC, LGSW |
| Practice Address |
1900 Silver Lake Rd, Suite 110 New Brighton MN 55112 |
| Mailing Address |
2221 Polk St Ne Minneapolis Mn MN 55418 |
| Practice Telephone | 8477215639 |
| Mailing Telephone | 8477215639 |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2016-10-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
303715 | MN | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225484694 | Evan Lieberman | Student in an Organized Health Care Education/Training Program | 506 Lenox Ave, Mlk #11101, New York, NY 10037-1802 | 2016-05-04 |
| Street Address |
1900 SILVER LAKE RD, SUITE 110 |
| City | NEW BRIGHTON |
| State | MN |
| Zip Code | 55112 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083133086 | Miranda Hedlund | Counselor | 1900 Silver Lake Rd, Suite 110, New Brighton, MN 55112 | 2017-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932729704 | Owegio Wreh | Technician | 1405 Silver Lake Road Suite 15, New Brighton, MN 55112 | 2020-04-22 |
| 1205497435 | Silver Lake Smiles Family Dentistry | Clinic/Center | 2370 Palmer Drive, New Brighton, MN 55112 | 2019-06-27 |
| 1932766169 | Matthew Thomas Hanowski | Dentist | 2442 Mounds View Boulevard, Mounds View, MN 55112 | 2019-05-22 |
| 1437619988 | Marjean Diane Leary | Registered Nurse | 338 New Brighton Road, Apt, Suite, Bldg. (optional), New Brighton, MN 55112 | 2019-03-21 |
| 1558802728 | Krishna Katira | Student in an Organized Health Care Education/Training Program | 2442 County Hwy 10, Mounds View, MN 55112 | 2017-03-20 |
| 1093262065 | Ryan Zinken | Nurse Practitioner | 1900 Silver Lake Road, Suite 110, New Brighton, MN 55112 | 2016-09-07 |
| 1447703228 | Alison Glodek | Social Worker | 2543 17th St Nw, New Brighton, MN 55112 | 2016-07-28 |
| 1659728194 | Ge Vang Sr. | Driver | 2160 County Road E West #205, 2160 County Road E West #205, New Brighton, MN 55112 | 2016-05-14 |
| 1114373578 | Jessica Gapinski | Specialist/Technologist | 3900 Bethel Drive, Arden Hills, MN 55112 | 2016-05-04 |
| 1891155909 | Dose Health LLC | Durable Medical Equipment & Medical Supplies | 1820 Old Highway 8 Nw, New Brighton, MN 55112 | 2016-03-02 |
| Find all providers in zip 55112 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164062113 | Corazon Gailor | Counselor | 649 Old Highway 8 Nw Apt 102, New Brighton, MN 55112-2866 | 2020-01-07 |
| 1730658352 | Kelley Ann Murphy | Counselor | 577 23rd Ave Nw, New Brighton, MN 55112-6518 | 2018-11-14 |
| 1306247531 | Julie Ann Theisen | Counselor | 2351 3rd Street Nw, 201, New Brighton, MN 55112 | 2014-09-08 |
| 1972931343 | James Hampton | Counselor | 1900 Silver Lake Rd., Suite 110, New Brighton, MN 55112 | 2013-10-23 |
| 1700953353 | Timothy Richard Brustad | Counselor | 626 Continental Dr, New Brighton, MN 55112-7641 | 2006-11-29 |
| 1326665662 | Jamie Mae Hammond | Counselor | 1900 Silver Lake Rd Nw Ste 110, New Brighton, MN 55112-1789 | 2020-07-02 |
| 1366069213 | Allyson Case | Counselor | 1900 Silver Lake Rd Nw Ste 110, New Brighton, MN 55112-1789 | 2020-06-26 |
| 1184247660 | Tammie Leetta Fullman | Counselor | 1900 Silver Lake Rd Nw, New Brighton, MN 55112-1786 | 2020-05-19 |
| 1396379541 | Meredith Lawlor | Counselor | 1900 Silver Lake Rd Nw, New Brighton, MN 55112-1786 | 2020-02-26 |
| 1851931596 | Emma Rose Keehr | Counselor | 1900 Silver Lake Rd Nw Ste 110, New Brighton, MN 55112-1789 | 2020-01-10 |
| Find all providers in NEW BRIGHTON | ||||
| City | NEW BRIGHTON |
| Zip Code | 55112 |
Please comment or provide details below to improve the information on EVAN FREDRICK LIEBERMAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.