Provider Demographics
NPI:1598789232
Name:RIEBE, ANN LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:LYNN
Last Name:RIEBE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:ANN
Other - Middle Name:LYNN
Other - Last Name:LINDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1375 LECH AVE NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1070
Mailing Address - Country:US
Mailing Address - Phone:321-956-1515
Mailing Address - Fax:
Practice Address - Street 1:600 E STRAWBRIDGE AVE
Practice Address - Street 2:SUITE 200 B
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4796
Practice Address - Country:US
Practice Address - Phone:321-956-1515
Practice Address - Fax:321-956-1357
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73817Medicare ID - Type Unspecified