Provider Demographics
NPI:1134141013
Name:KIBRICK, STEPHEN ARTHUR (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ARTHUR
Last Name:KIBRICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4766 PARK GRANADA STE 208
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3339
Mailing Address - Country:US
Mailing Address - Phone:818-222-2024
Mailing Address - Fax:818-999-4655
Practice Address - Street 1:4766 PARK GRANADA STE 208
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-3339
Practice Address - Country:US
Practice Address - Phone:818-222-2024
Practice Address - Fax:818-999-4655
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4702103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY4702OtherCA STATE LICENSE #
CAPSY4702OtherCA STATE LICENSE #