Provider Demographics
NPI:1366805111
Name:SIBLEY, MARISSA (MS)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:SIBLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 S MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-1521
Mailing Address - Country:US
Mailing Address - Phone:305-205-5157
Mailing Address - Fax:
Practice Address - Street 1:9101 DUCALE WAY
Practice Address - Street 2:APT 202
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-8132
Practice Address - Country:US
Practice Address - Phone:305-205-5157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 14046101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health