Provider Demographics
NPI:1801216296
Name:NIBLICK, ALISON (PSYD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:NIBLICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 SCHAEFFER DR
Mailing Address - Street 2:
Mailing Address - City:WALNUTPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18088-9593
Mailing Address - Country:US
Mailing Address - Phone:484-714-0376
Mailing Address - Fax:
Practice Address - Street 1:4011 SCHAEFFER DR
Practice Address - Street 2:
Practice Address - City:WALNUTPORT
Practice Address - State:PA
Practice Address - Zip Code:18088-9593
Practice Address - Country:US
Practice Address - Phone:484-714-0376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY164819103TC0700X
PAPS01958103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104004010-0001Medicaid