Provider Demographics
NPI:1760907703
Name:LIFFLAND, CORRIE L (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:L
Last Name:LIFFLAND
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:CORRIE
Other - Middle Name:L
Other - Last Name:RACHINSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1187 ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10590-1434
Mailing Address - Country:US
Mailing Address - Phone:845-901-7143
Mailing Address - Fax:
Practice Address - Street 1:1187 ROUTE 35
Practice Address - Street 2:
Practice Address - City:SOUTH SALEM
Practice Address - State:NY
Practice Address - Zip Code:10590-1434
Practice Address - Country:US
Practice Address - Phone:845-901-7143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1101103K00000X
NY001615103K00000X
VA0133001901103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst