MEDICARE: MS. DANIELLE HEATHER LEIBERT M.S. SLP , TSSLD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	023953	NY
2	235Z00000X	Speech-Language Pathologist	023953-1	NY
3	235Z00000X	Speech-Language Pathologist	004876	CT

General Provider Information

NPI Number	:	1457752867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANIELLE HEATHER LEIBERT M.S. SLP , TSSLD

Provider Business Mailing Address
First Line	:	9 COLLINGSWOOD RD
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-3911
Country	:	US
Telephone Number	:	845-642-6173
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 COLLINGSWOOD RD
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-3911
Country	:	US
Telephone Number	:	845-642-6173
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2014
Last Update Date	:	09/05/2014

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