Provider Demographics
NPI:1285794727
Name:LEIB, NAOMI RIVKAH (PSYD)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:RIVKAH
Last Name:LEIB
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W 79TH ST
Mailing Address - Street 2:#1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-496-0744
Mailing Address - Fax:718-796-8694
Practice Address - Street 1:124 W 79TH ST
Practice Address - Street 2:#1D
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-496-0744
Practice Address - Fax:718-796-8694
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009388103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical