Provider Demographics
NPI:1629545629
Name:DEBRA LYNN STIBICK, PH.D., LLC
Entity Type:Organization
Organization Name:DEBRA LYNN STIBICK, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STIBICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-490-2040
Mailing Address - Street 1:PO BOX 3236
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33775-3236
Mailing Address - Country:US
Mailing Address - Phone:520-490-2040
Mailing Address - Fax:727-565-4188
Practice Address - Street 1:8130 66TH ST N STE 10
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2111
Practice Address - Country:US
Practice Address - Phone:520-490-2040
Practice Address - Fax:727-565-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-28
Last Update Date:2018-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty