Healthcare Provider Details

I. General information

NPI: 1063435279
Provider Name (Legal Business Name): RICHARD J. LOEBL LCSW, BCD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7284 W PALMETTO PARK RD SUITE 201
BOCA RATON FL
33433-3406
US

IV. Provider business mailing address

381 NW 36TH AVE
DEERFIELD BEACH FL
33442-8013
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-6090
  • Fax:
Mailing address:
  • Phone: 561-955-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW6025
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: