Provider Demographics
NPI:1770622037
Name:LEDERER, BARBRA SUE
Entity type:Individual
Prefix:MRS
First Name:BARBRA
Middle Name:SUE
Last Name:LEDERER
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:BARBRA
Other - Middle Name:SUE
Other - Last Name:LEDERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2218
Mailing Address - Country:US
Mailing Address - Phone:516-536-1007
Mailing Address - Fax:516-764-6941
Practice Address - Street 1:14 BUCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-2218
Practice Address - Country:US
Practice Address - Phone:516-536-1007
Practice Address - Fax:516-764-6941
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003302-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist