Provider Demographics
NPI:1497954549
Name:BILD-LIBBIN, RAQUEL (PHD)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:
Last Name:BILD-LIBBIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 AVENTURA BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3120
Mailing Address - Country:US
Mailing Address - Phone:305-865-7551
Mailing Address - Fax:
Practice Address - Street 1:2845 AVENTURA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3120
Practice Address - Country:US
Practice Address - Phone:305-865-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY00002824103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75765AMedicare PIN