Provider Demographics
NPI:1730642323
Name:LEIBOWITZ, FREDERICK ISIDORE (MS ED)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:ISIDORE
Last Name:LEIBOWITZ
Suffix:
Gender:M
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6410
Mailing Address - Country:US
Mailing Address - Phone:646-327-1691
Mailing Address - Fax:
Practice Address - Street 1:389 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6410
Practice Address - Country:US
Practice Address - Phone:646-327-1691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst