Healthcare Provider Details

I. General information

NPI: 1255151635
Provider Name (Legal Business Name): LIORA SARAH HYMAN MT-BC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 FULLER RD
ALBANY NY
12205-5734
US

IV. Provider business mailing address

489 WESTERN AVE APT 1
ALBANY NY
12203-1512
US

V. Phone/Fax

Practice location:
  • Phone: 518-641-1971
  • Fax:
Mailing address:
  • Phone: 631-807-2983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number19143
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: