Provider Demographics
NPI:1598308694
Name:LIBA, LLC.
Entity Type:Organization
Organization Name:LIBA, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:LUBOV
Authorized Official - Last Name:LUTSKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP, TSSLD
Authorized Official - Phone:718-594-7747
Mailing Address - Street 1:66 CORBIN PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4804
Mailing Address - Country:US
Mailing Address - Phone:718-594-7747
Mailing Address - Fax:
Practice Address - Street 1:704 AVENUE X FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6121
Practice Address - Country:US
Practice Address - Phone:718-594-7747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty