Healthcare Provider Details

I. General information

NPI: 1134879059
Provider Name (Legal Business Name): ALISON NIBLICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 SCHAEFFER DR
WALNUTPORT PA
18088-9593
US

IV. Provider business mailing address

4011 SCHAEFFER DR
WALNUTPORT PA
18088-9593
US

V. Phone/Fax

Practice location:
  • Phone: 484-714-0376
  • Fax:
Mailing address:
  • Phone: 484-714-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ALISON NIBLICK
Title or Position: LICENSED PSYCHOLOGIST, BUSINESS OWN
Credential: PSYD
Phone: 484-714-0376