Healthcare Provider Details

I. General information

NPI: 1841473600
Provider Name (Legal Business Name): TASHA HIBBERT PSY. D., MCAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15263 SUMMER LAKE DR
DELRAY BEACH FL
33446-3452
US

IV. Provider business mailing address

15263 SUMMER LAKE DR
DELRAY BEACH FL
33446-3452
US

V. Phone/Fax

Practice location:
  • Phone: 305-812-9111
  • Fax:
Mailing address:
  • Phone: 305-812-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMCAP100092
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY12400
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: