Provider Demographics
NPI:1477373934
Name:GRABER, LIAT RIVKA SEGAL (PHD)
Entity type:Individual
Prefix:DR
First Name:LIAT
Middle Name:RIVKA SEGAL
Last Name:GRABER
Suffix:
Gender:
Credentials:PHD
Other - Prefix:DR
Other - First Name:LIAT
Other - Middle Name:RIVKA
Other - Last Name:SEGAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:667 STONELEIGH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-2455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11835 QUEENS BLVD STE 1630
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7256
Practice Address - Country:US
Practice Address - Phone:845-279-5908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTP233-005103TC0700X
NY027090103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical