Provider Demographics
NPI:1467044594
Name:GISELLE LEIBOVITCH, PHD, LLC
Entity Type:Organization
Organization Name:GISELLE LEIBOVITCH, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GISELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIBOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-817-1137
Mailing Address - Street 1:7274 NW 68TH DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4730
Mailing Address - Country:US
Mailing Address - Phone:954-817-1137
Mailing Address - Fax:
Practice Address - Street 1:7274 NW 68TH DR
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-4730
Practice Address - Country:US
Practice Address - Phone:954-817-1137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty