Provider Demographics
NPI:1033760186
Name:KOBERNICK, CHAYA LIEBA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHAYA
Middle Name:LIEBA
Last Name:KOBERNICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13523 78TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3239
Mailing Address - Country:US
Mailing Address - Phone:917-494-3708
Mailing Address - Fax:
Practice Address - Street 1:13523 78TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3239
Practice Address - Country:US
Practice Address - Phone:917-494-3708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP102639103TC0700X
NY023935103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP102639OtherNA
NYP102639Medicaid