Provider Demographics
NPI:1821491309
Name:NIBLO, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:NIBLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HARRIMAN DR
Mailing Address - Street 2:ORANGE INTENSIVE DAY TREATMENT, OU BOCES-ARDEN HILL
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-2410
Mailing Address - Country:US
Mailing Address - Phone:845-615-0224
Mailing Address - Fax:845-615-0229
Practice Address - Street 1:4 HARRIMAN DR
Practice Address - Street 2:ORANGE INTENSIVE DAY TREATMENT, OU BOCES-ARDEN HILL
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2410
Practice Address - Country:US
Practice Address - Phone:845-615-0224
Practice Address - Fax:845-615-0229
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY78803721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical