Provider Demographics
NPI:1184024341
Name:DAMON LABARBERA, PHD
Entity Type:Organization
Organization Name:DAMON LABARBERA, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:LABARBERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-763-2984
Mailing Address - Street 1:439 GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2721
Mailing Address - Country:US
Mailing Address - Phone:850-763-2984
Mailing Address - Fax:904-214-0022
Practice Address - Street 1:439 GRACE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2721
Practice Address - Country:US
Practice Address - Phone:850-763-2984
Practice Address - Fax:904-214-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004085103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73473Medicare UPIN