Healthcare Provider Details

I. General information

NPI: 1801295472
Provider Name (Legal Business Name): RICHARD H HIBBERT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SUMMIT AVE
HACKENSACK NJ
07601-1429
US

IV. Provider business mailing address

331 SUMMIT AVE
HACKENSACK NJ
07601-1429
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-0408
  • Fax: 201-488-0411
Mailing address:
  • Phone: 201-488-0408
  • Fax: 201-488-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number73074744
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05591600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: