Provider Demographics
NPI:1023384823
Name:LIBBY, ELLEN WEBER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:WEBER
Last Name:LIBBY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 HARNESS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1617
Mailing Address - Country:US
Mailing Address - Phone:410-990-0214
Mailing Address - Fax:410-990-0215
Practice Address - Street 1:1231 POTOMAC ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3230
Practice Address - Country:US
Practice Address - Phone:202-333-4250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1010103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist