Provider Demographics
NPI:1033745401
Name:HIBMA, ADAM (PSYD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:HIBMA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 W BUENA AVE APT 1703
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6603
Mailing Address - Country:US
Mailing Address - Phone:763-350-3588
Mailing Address - Fax:
Practice Address - Street 1:833 W BUENA AVE APT 1703
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-6603
Practice Address - Country:US
Practice Address - Phone:763-350-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010151103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical