Provider Demographics
NPI:1730366428
Name:DEBORAH J. RIBNICK, PHD, PC
Entity type:Organization
Organization Name:DEBORAH J. RIBNICK, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIBNICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:775-786-1234
Mailing Address - Street 1:5595 KIETZKE LN
Mailing Address - Street 2:SUITE 110E
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3029
Mailing Address - Country:US
Mailing Address - Phone:775-786-1234
Mailing Address - Fax:775-852-7169
Practice Address - Street 1:5595 KIETZKE LN
Practice Address - Street 2:SUITE 110E
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3029
Practice Address - Country:US
Practice Address - Phone:775-786-1234
Practice Address - Fax:775-852-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0319261QM0850X, 261QM0855X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV34267OtherMEDICARE ID NUMBER
NV002616072Medicaid
NV002616072Medicaid