Basic Information
Provider Information
NPI: 1356837249
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TIBERT
FirstName: ROBYN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 22 W DRY CREEK CIR
Address2:  
City: LITTLETON
State: CO
PostalCode: 801204413
CountryCode: US
TelephoneNumber: 3037304700
FaxNumber: 3037304790
Practice Location
Address1: 22 W DRY CREEK CIR
Address2:  
City: LITTLETON
State: CO
PostalCode: 801204413
CountryCode: US
TelephoneNumber: 3037304700
FaxNumber: 3037304790
Other Information
ProviderEnumerationDate: 07/03/2018
LastUpdateDate: 07/03/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XCSW.09924028COY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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