Provider Demographics
NPI:1184054686
Name:RYBACK, GITTIE (LCSW)
Entity type:Individual
Prefix:
First Name:GITTIE
Middle Name:
Last Name:RYBACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1866
Mailing Address - Country:US
Mailing Address - Phone:732-447-8788
Mailing Address - Fax:732-942-6055
Practice Address - Street 1:1072 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2650
Practice Address - Country:US
Practice Address - Phone:732-447-8788
Practice Address - Fax:732-942-6055
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053784001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical