Healthcare Provider Details

I. General information

NPI: 1205644069
Provider Name (Legal Business Name): HADASSAH LIEBERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SCHUNNEMUNK RD UNIT 112
MONROE NY
10950-6257
US

IV. Provider business mailing address

6 BRIDLE CT
JACKSON NJ
08527-4488
US

V. Phone/Fax

Practice location:
  • Phone: 845-477-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: