Provider Demographics
NPI:1326151697
Name:GIBLIN, PAUL ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
Last Name:GIBLIN
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 1:820 N MICHIGAN AVE
Mailing Address - Street 2:LT 633
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2147
Mailing Address - Country:US
Mailing Address - Phone:312-915-7483
Mailing Address - Fax:312-915-7410
Practice Address - Street 1:820 N MICHIGAN AVE
Practice Address - Street 2:LT 633
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2147
Practice Address - Country:US
Practice Address - Phone:312-915-7483
Practice Address - Fax:312-915-7410
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166-000261106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist