Provider Demographics
NPI:1740321124
Name:LEBO, ROBERT BRADLEY (PH D)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRADLEY
Last Name:LEBO
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:DR
Other - First Name:R BRAD
Other - Middle Name:
Other - Last Name:LEBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PH D, PLLC
Mailing Address - Street 1:121 NORTHWEST ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3550
Mailing Address - Country:US
Mailing Address - Phone:603-502-9955
Mailing Address - Fax:
Practice Address - Street 1:58 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-2044
Practice Address - Country:US
Practice Address - Phone:603-502-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH777103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010606Medicaid
NH30010606Medicaid