Individual
DR. KENNETH B LIBERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
175 W BROADWAY, LINCOLN, ME 04457-4000
(207) 794-6700
Mailing address
175 W BROADWAY, LINCOLN, ME 04457-4000
(207) 794-6700
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS1359
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103T00000X
ANTHEM BLUE CROSS
ME
Enumeration date
10/19/2012
Last updated
02/26/2015
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