Provider Demographics
NPI:1437446531
Name:LIEBERMAN, RITA JANE (PHD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:JANE
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 ANNA CATHERINE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7410
Mailing Address - Country:US
Mailing Address - Phone:407-382-7908
Mailing Address - Fax:
Practice Address - Street 1:12424 RESEARCH PKWY
Practice Address - Street 2:SUITE 155
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-3249
Practice Address - Country:US
Practice Address - Phone:407-882-0468
Practice Address - Fax:407-249-4774
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-09
Last Update Date:2011-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10861235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist