Provider Demographics
NPI:1871182147
Name:GOLDBERGER, LEAH SARA (MS-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:SARA
Last Name:GOLDBERGER
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SAINT EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3184
Mailing Address - Country:US
Mailing Address - Phone:718-834-6756
Mailing Address - Fax:
Practice Address - Street 1:51 SAINT EDWARDS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3184
Practice Address - Country:US
Practice Address - Phone:718-834-6756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030346235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist