Provider Demographics
NPI:1407890585
Name:GOODMAN LIEBESKIND, PAULA J (AUD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:J
Last Name:GOODMAN LIEBESKIND
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15280 NW 79TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5873
Mailing Address - Country:US
Mailing Address - Phone:305-558-3724
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:21097 NE 27TH CT STE 410
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1249
Practice Address - Country:US
Practice Address - Phone:954-932-6375
Practice Address - Fax:954-932-9002
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1075231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6004300Medicaid
FLU1562AOtherLEGACY
FLU1562AMedicare PIN