Healthcare Provider Details

I. General information

NPI: 1699107326
Provider Name (Legal Business Name): RACHEL LIEBESKIND MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 GUY LOMBARDO AVE UNIT 1 SOUTH SHORE CHILD GUIDANCE CENTER
FREEPORT NY
11520-3731
US

IV. Provider business mailing address

239 FRANKEL BLVD
MERRICK NY
11566-4796
US

V. Phone/Fax

Practice location:
  • Phone: 516-868-3030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number089607
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: