Provider Demographics
NPI:1043752157
Name:LIBROIA, JESSICA (MA)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:LIBROIA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 E 6TH ST
Mailing Address - Street 2:APT. 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-6626
Mailing Address - Country:US
Mailing Address - Phone:646-271-3737
Mailing Address - Fax:
Practice Address - Street 1:519 E 6TH ST
Practice Address - Street 2:APT. 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-6626
Practice Address - Country:US
Practice Address - Phone:646-271-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program