Provider Demographics
NPI:1073989075
Name:HILL-LIBURD, CHYNIQUA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CHYNIQUA
Middle Name:
Last Name:HILL-LIBURD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 BAINBRIDGE AVE
Mailing Address - Street 2:3B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2831
Mailing Address - Country:US
Mailing Address - Phone:347-597-5066
Mailing Address - Fax:
Practice Address - Street 1:2839 BAINBRIDGE AVE
Practice Address - Street 2:3B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2831
Practice Address - Country:US
Practice Address - Phone:347-597-5066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091734-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY252Y00000XOtherEARLY INTERVENTION PROVIDER AGENCY