Provider Demographics
NPI:1831559723
Name:LEIBOWITZ, PAMELA (MA CCC-SLP TSSLD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:LEIBOWITZ
Suffix:
Gender:F
Credentials:MA CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2794 MANDALAY BEACH RD
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-4629
Mailing Address - Country:US
Mailing Address - Phone:516-426-4074
Mailing Address - Fax:
Practice Address - Street 1:1210 150TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1748
Practice Address - Country:US
Practice Address - Phone:718-728-8476
Practice Address - Fax:718-747-6675
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025374235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist