Provider Demographics
NPI:1740796077
Name:RIBBECK, JEFFREY E
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
Last Name:RIBBECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E AND WEST RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3602
Mailing Address - Country:US
Mailing Address - Phone:716-677-7152
Mailing Address - Fax:716-677-7074
Practice Address - Street 1:1010 E AND WEST RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3602
Practice Address - Country:US
Practice Address - Phone:716-677-7152
Practice Address - Fax:716-677-7074
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074029-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical