Healthcare Provider Details

I. General information

NPI: 1396586962
Provider Name (Legal Business Name): SHOSHANA LIEBERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 DEEP WELL FARMS RD
SOUTH SALEM NY
10590-1916
US

IV. Provider business mailing address

277 E AMADOR AVE STE 101
LAS CRUCES NM
88001-3675
US

V. Phone/Fax

Practice location:
  • Phone: 914-671-3175
  • Fax:
Mailing address:
  • Phone: 575-520-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: