=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497193445
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD R SIBLEY JR. LCSW-R
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2013
-----------------------------------------------------
Last Update Date | 05/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 76 BROAD AVE
-----------------------------------------------------
City | BINGHAMTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13904-1406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-237-0005
-----------------------------------------------------
Fax | 607-217-4253
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 76 BROAD AVE
-----------------------------------------------------
City | BINGHAMTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13904-1406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-237-0005
-----------------------------------------------------
Fax | 607-217-4253
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 087178-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------