DR. KENNETH B LIBERTY (PH.D.) – Clinical Psychologist, NPI 1124371778

DR. KENNETH B LIBERTY (PH.D.) is a healthcare provider. based in Lincoln, Maine. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials PH.D.. They hold a License No. PS1359 (ME). The NPI Number for DR. KENNETH B LIBERTY (PH.D.) is 1124371778

Main info

Male
24 Years Of Experience
Accepts Medicare Assignment
Name
DR. KENNETH B LIBERTY (PH.D.)
NPI
1124371778
Phone
(207) 794-6700
Address
175 W BROADWAY
Enumeration Date
19 October 2012
Last Update Date
26 February 2015

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2079423816
Graduation Year
2002 (24 years ago)
PAC ID
8820240112
Group Practice PAC ID
5092709345
Professional Enrollment ID
I20121213000188
Address ID
ME044013500BA444XXAVEX320
Telehealth
Yes
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience40
Completeness75
Years active:13State licenses:1Digital endpointsOther names

173 CLINICAL PSYCHOLOGIST in ME

Provider Addresses for DR. KENNETH B LIBERTY (PH.D.)

  • 175 W BROADWAY

    LINCOLN, ME 044574000

    Phone: (207) 794-6700

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2012-12-13

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20121213000188IClinical PsychologistMETBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 04457)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5092709345View full group profile
NameSpecialtyState
Clinical Social WorkerME
-ME
Clinical Social WorkerME
Clinical Social WorkerME

Reviews

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Frequently asked questions

Can I verify DR. KENNETH B LIBERTY (PH.D.) with an NPI only?
You can start verification with NPI 1124371778 for DR. KENNETH B LIBERTY (PH.D.), then check state licensing separately.
Is DR. KENNETH B LIBERTY (PH.D.) still practicing?
DR. KENNETH B LIBERTY (PH.D.) is currently listed as active in the public NPI registry.
What is DR. KENNETH B LIBERTY (PH.D.)'s specialty?
The listing groups DR. KENNETH B LIBERTY (PH.D.) with Clinical Psychologist. Clinical services aligned with this taxonomy classification.
What address line appears for DR. KENNETH B LIBERTY (PH.D.)?
DR. KENNETH B LIBERTY (PH.D.)'s geographic hint is Lincoln, Maine in our summary view.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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