1225793854 NPI number — DR. ELISE RIBAS LISBOA PHD IN PSYCHOLOGY

Table of content: DR. ELISE RIBAS LISBOA PHD IN PSYCHOLOGY (NPI 1225793854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225793854 NPI number — DR. ELISE RIBAS LISBOA PHD IN PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LISBOA
Provider First Name:
ELISE
Provider Middle Name:
RIBAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD IN PSYCHOLOGY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225793854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 RUBY AVE STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34741-5698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-272-0147
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RUA DESEMBARGADOR FERREIRA FRANCA 40
Provider Second Line Business Practice Location Address:
APARTMENT 174B
Provider Business Practice Location Address City Name:
SAO PAULO
Provider Business Practice Location Address State Name:
SAO PAULO
Provider Business Practice Location Address Postal Code:
05446050
Provider Business Practice Location Address Country Code:
BR
Provider Business Practice Location Address Telephone Number:
406-272-0147
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  BBH-LCPC-LIC-30205 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com