Provider Demographics
NPI:1760475305
Name:HIBBS, B JANET (PHD)
Entity Type:Individual
Prefix:
First Name:B JANET
Middle Name:
Last Name:HIBBS
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 1:2130 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6535
Mailing Address - Country:US
Mailing Address - Phone:215-731-0773
Mailing Address - Fax:
Practice Address - Street 1:2130 PINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6535
Practice Address - Country:US
Practice Address - Phone:215-731-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003912L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA092117Medicare ID - Type UnspecifiedPSYCHOLOGIST