Provider Demographics
NPI:1841473600
Name:HIBBERT, TASHA (PSY D, MCAP)
Entity type:Individual
Prefix:DR
First Name:TASHA
Middle Name:
Last Name:HIBBERT
Suffix:
Gender:F
Credentials:PSY D, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15263 SUMMER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3452
Mailing Address - Country:US
Mailing Address - Phone:305-812-9111
Mailing Address - Fax:
Practice Address - Street 1:15263 SUMMER LAKE DR
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3452
Practice Address - Country:US
Practice Address - Phone:305-812-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMCAP100092101YA0400X
FLPY12400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMCAP100092OtherTHE FLORIDA CERTIFICATION BOARD
FLPY12400OtherLICENSED PSYCHOLOGIST