Healthcare Provider Details

I. General information

NPI: 1538156955
Provider Name (Legal Business Name): YEHUDA LIEBERMAN LCSW-R, DCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 NAPOLEON ST
WOODMERE NY
11598-2317
US

IV. Provider business mailing address

833 NAPOLEON ST
WOODMERE NY
11598-2317
US

V. Phone/Fax

Practice location:
  • Phone: 516-218-4200
  • Fax: 718-362-1639
Mailing address:
  • Phone: 516-218-4200
  • Fax: 718-362-1639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR056473
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: