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General NPI Number Information
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NPI Number | 1447412531
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Entity Type | Individual
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Provider Name | ILONA ELISABETH LIBANSKY PH.D., LMFT, CAC
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Gender | Female
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 7880 N UNIVERSITY DR SUITE 202
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City | TAMARAC
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State | FL
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Zip | 33321-2124
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Country | US
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Telephone | 954-829-5080
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Fax | 954-571-7734
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Provider Business Mailing Address
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Address Line | 2621 NE 52ND ST
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City | LIGHTHOUSE POINT
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State | FL
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Zip | 33064-7051
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Country | US
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Telephone | 954-829-5080
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Fax | 954-571-7734
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT 1940
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License Number State | FL
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