Provider Demographics
NPI:1881350460
Name:LIEBERMAN, REBECCA B (PSYD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:B
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:B
Other - Last Name:DIENSTAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:528 MEEHAN AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5429
Mailing Address - Country:US
Mailing Address - Phone:516-410-3054
Mailing Address - Fax:
Practice Address - Street 1:17 PURDY AVE
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2959
Practice Address - Country:US
Practice Address - Phone:212-696-1355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024651-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical