Provider Demographics
NPI:1245528843
Name:SIBO, BRIDGET K (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:K
Last Name:SIBO
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 1:2453 KNIGHTS BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-2892
Mailing Address - Country:US
Mailing Address - Phone:708-220-3320
Mailing Address - Fax:
Practice Address - Street 1:2453 KNIGHTS BRIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385
Practice Address - Country:US
Practice Address - Phone:708-220-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-16
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0143361041C0700X
IN34007128A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical