Provider Demographics
NPI:1336527860
Name:LIEBMAN, SHIRA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHIRA
Middle Name:
Last Name:LIEBMAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:SHIRA
Other - Middle Name:
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:16 SANDY CT
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1736
Mailing Address - Country:US
Mailing Address - Phone:516-695-4341
Mailing Address - Fax:
Practice Address - Street 1:16 SANDY CT
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-1736
Practice Address - Country:US
Practice Address - Phone:516-695-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-17
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021160-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist