Provider Demographics
NPI:1669804761
Name:HIBBERT, DEVON RECKMEYER (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEVON
Middle Name:RECKMEYER
Last Name:HIBBERT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DEVON
Other - Middle Name:RECKMEYER
Other - Last Name:HIBBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1580 NORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5321
Mailing Address - Country:US
Mailing Address - Phone:408-915-7945
Mailing Address - Fax:
Practice Address - Street 1:7707 AUSTIN RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95215-8312
Practice Address - Country:US
Practice Address - Phone:408-915-7945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist