Provider Demographics
NPI:1720200215
Name:PHIBBS, JUDITH ANN (PHD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:PHIBBS
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 1:585 MAIN ST
Mailing Address - Street 2:SUITE 143
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4354
Mailing Address - Country:US
Mailing Address - Phone:301-490-0779
Mailing Address - Fax:301-490-4663
Practice Address - Street 1:585 MAIN ST
Practice Address - Street 2:SUITE 143
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4354
Practice Address - Country:US
Practice Address - Phone:301-490-0778
Practice Address - Fax:301-490-4663
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02277103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist