Healthcare Provider Details

I. General information

NPI: 1215265533
Provider Name (Legal Business Name): JOHANNAH HIBBS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2089 3RD AVE
NEW YORK NY
10029-2184
US

IV. Provider business mailing address

2089 3RD AVE
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-828-6144
  • Fax:
Mailing address:
  • Phone: 212-828-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007286
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number080011
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: