Provider Demographics
NPI:1114460680
Name:LIEBERMAN, CHANNAH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHANNAH
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:CHANNAH
Other - Middle Name:
Other - Last Name:CYRULNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:684 CROWN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5304
Mailing Address - Country:US
Mailing Address - Phone:718-735-7596
Mailing Address - Fax:
Practice Address - Street 1:100 NOLL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4723
Practice Address - Country:US
Practice Address - Phone:347-276-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012282235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist