Individual provider Active NPI

Erin Marie Liebich, PSY.D.

  • Clinical Psychologist
  • Carol Stream, IL
National Provider Identifier
1821221326
Registry record updated Oct 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071.008385 Issued in IL
Practice address
640 E Saint Charles Rd Ste 212
Carol Stream, IL 60188-2600
Phone
(630) 791-0118
Fax
(630) 708-7654
NPI assigned
Aug 31, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 071.008385 IL Primary

Addresses

Primary practice location

640 E Saint Charles Rd Ste 212
Carol Stream, IL 60188-2600

Mailing address

640 E Saint Charles Rd Ste 212
Carol Stream, IL 60188-2600
Phone (630) 791-0118

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131204000288 IL Practitioner - Clinical Psychologist 9537395173 Practice locations: Carol Stream, IL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

640 E Saint Charles Rd
Suite 212
Carol Stream, IL 60188-2600
Phone (630) 791-0118

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071.008385ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Personal Growth, PLLC Clinical CurrentSince Sep 17, 2013 Accepting new patients

Locations

640 E Saint Charles Rd
Ste 212
Carol Stream, IL 60188
Phone (630) 791-0118

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665964800000",
    "number": "1821221326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 E SAINT CHARLES RD STE 212",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882600",
            "telephone_number": "630-791-0118",
            "fax_number": "630-708-7654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 E SAINT CHARLES RD STE 212",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882600",
            "telephone_number": "630-791-0118",
            "fax_number": "630-708-7654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBICH",
        "first_name": "ERIN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-31",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.008385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carol Stream, IL

Sources for this page

Verify at the official NPI Registry.