Provider Demographics
NPI:1538156955
Name:LIEBERMAN, YEHUDA (LCSW-R, DCSW)
Entity type:Individual
Prefix:
First Name:YEHUDA
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:LCSW-R, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 NAPOLEON ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2317
Mailing Address - Country:US
Mailing Address - Phone:516-218-4200
Mailing Address - Fax:718-362-1639
Practice Address - Street 1:833 NAPOLEON ST
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2317
Practice Address - Country:US
Practice Address - Phone:516-218-4200
Practice Address - Fax:718-362-1639
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0564731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02536414Medicaid
NYN3L102Medicare ID - Type Unspecified
NY02536414Medicaid