Provider Demographics
NPI:1417118050
Name:NAIBURG, JODIE M (MA)
Entity Type:Individual
Prefix:MISS
First Name:JODIE
Middle Name:M
Last Name:NAIBURG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1807
Mailing Address - Country:US
Mailing Address - Phone:267-902-2165
Mailing Address - Fax:
Practice Address - Street 1:1016 WARRIOR RD
Practice Address - Street 2:SUITE A
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4818
Practice Address - Country:US
Practice Address - Phone:267-902-2165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional