Provider Demographics
NPI:1659412716
Name:LEIBOWITZ, IRWIN (PHD)
Entity Type:Individual
Prefix:
First Name:IRWIN
Middle Name:
Last Name:LEIBOWITZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 BROOK FARM RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10506-1311
Mailing Address - Country:US
Mailing Address - Phone:914-234-2151
Mailing Address - Fax:
Practice Address - Street 1:48 BROOK FARM RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NY
Practice Address - Zip Code:10506-1311
Practice Address - Country:US
Practice Address - Phone:914-234-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009189103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral