Provider Demographics
NPI:1881965424
Name:LIEBES, GOLDIE B (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:GOLDIE
Middle Name:B
Last Name:LIEBES
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:GOLDIE
Other - Middle Name:B
Other - Last Name:PINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:2409 SHELLEYDALE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3209
Mailing Address - Country:US
Mailing Address - Phone:443-310-3469
Mailing Address - Fax:443-276-5857
Practice Address - Street 1:2409 SHELLEYDALE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3209
Practice Address - Country:US
Practice Address - Phone:443-310-3469
Practice Address - Fax:443-276-5857
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist