Provider Demographics
NPI:1225155088
Name:MESIBOV, GARY B (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:B
Last Name:MESIBOV
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 1:710A GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-5923
Mailing Address - Country:US
Mailing Address - Phone:919-966-8189
Mailing Address - Fax:919-966-4127
Practice Address - Street 1:DIVISION TEACCH CB 7180 UNIVERSITY OF NORTH CAROLINA
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7180
Practice Address - Country:US
Practice Address - Phone:919-966-8189
Practice Address - Fax:919-966-4127
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC470103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist