Active NPI
Paul Benjamin Lieberman, M.D.
- Psychiatry Physician
- Providence, RI
National Provider Identifier
1194753343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD9290
- Practice address
- 345 Blackstone Blvd
Providence, RI 02906-4800 - Phone
- (401) 455-6473
- Fax
- (401) 455-6229
- NPI assigned
- Jun 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD9290 | RI | Primary |
Addresses
Primary practice location
345 Blackstone Blvd
Providence, RI 02906-4800
Mailing address
345 Blackstone Blvd
Providence, RI 02906
Phone (401) 351-3374
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in RI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050616000540 | RI | Practitioner - Psychiatry | 6507800919 | Practice locations: Providence, RI |
Care Compare profile
Medicare Care Compare- Specialty
- Psychiatry
- Education
- Harvard Medical School, 1975
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
11 S Angell St
Suite 425
Providence, RI 02906-5206
Phone (401) 450-2676
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD9290 | RI | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379030400000",
"number": "1194753343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "345 BLACKSTONE BLVD",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "02906",
"telephone_number": "401-351-3374",
"fax_number": "401-455-6229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "345 BLACKSTONE BLVD",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029064800",
"telephone_number": "401-455-6473",
"fax_number": "401-455-6229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIEBERMAN",
"first_name": "PAUL",
"middle_name": "BENJAMIN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-28",
"last_updated": "2013-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "RI",
"license": "MD9290",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.