Provider Demographics
NPI:1902217243
Name:LIEBERMAN, RUTH (RN, LMHC)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:RN, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 ZOE ST
Mailing Address - Street 2:APT. 5B
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1101
Mailing Address - Country:US
Mailing Address - Phone:917-502-5210
Mailing Address - Fax:718-948-1479
Practice Address - Street 1:3930 RICHMOND AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312
Practice Address - Country:US
Practice Address - Phone:917-502-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP92495101YM0800X
NY481182163W00000X
NY006907-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse