Provider Demographics
NPI:1568986008
Name:LIBERTY, SHLOMIT BROSH (MA, MS)
Entity Type:Individual
Prefix:MS
First Name:SHLOMIT
Middle Name:BROSH
Last Name:LIBERTY
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 NOTRE DAME AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1841
Mailing Address - Country:US
Mailing Address - Phone:646-881-0940
Mailing Address - Fax:
Practice Address - Street 1:1300 NOTRE DAME AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-1841
Practice Address - Country:US
Practice Address - Phone:646-881-0940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026617-1235Z00000X
CA25719235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist