Individual
DR. BENJAMIN LALIBERTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2870 NE WEST DEVILS LAKE RD, LINCOLN CITY, OR 97367-5127
(541) 994-9191
Mailing address
PO BOX 1194, CORVALLIS, OR 97339-1194
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3262
OR
103TC0700X
Clinical Psychologist
6301017255
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6301017255
LICENSED PSYCHOLOGIST
MI
Enumeration date
10/15/2018
Last updated
11/04/2020
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