Provider Demographics
NPI:1912065293
Name:BLEIBERG, MAYER S (CRC LMHC)
Entity Type:Individual
Prefix:MR
First Name:MAYER
Middle Name:S
Last Name:BLEIBERG
Suffix:
Gender:M
Credentials:CRC LMHC
Other - Prefix:MR
Other - First Name:MARC
Other - Middle Name:
Other - Last Name:BLEIBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:510 JORGEN STREET
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559
Mailing Address - Country:US
Mailing Address - Phone:516-295-0992
Mailing Address - Fax:516-295-3664
Practice Address - Street 1:111 LIVINGSTON STREET RM 2222
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-802-4923
Practice Address - Fax:718-834-3716
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18001841 LMHC101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor