Provider Demographics
NPI:1326078718
Name:TIBOR, RICHARD STEVEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STEVEN
Last Name:TIBOR
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 1:502 TORRACE BLVD.
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278
Mailing Address - Country:US
Mailing Address - Phone:310-316-0811
Mailing Address - Fax:310-540-8932
Practice Address - Street 1:502 TORRANCE BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3413
Practice Address - Country:US
Practice Address - Phone:310-316-0811
Practice Address - Fax:310-540-8932
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 12809103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical