Provider Demographics
NPI:1871743377
Name:RYBO, JENS VALDEMAR (LMHC)
Entity type:Individual
Prefix:MR
First Name:JENS
Middle Name:VALDEMAR
Last Name:RYBO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3806
Mailing Address - Country:US
Mailing Address - Phone:617-276-5964
Mailing Address - Fax:
Practice Address - Street 1:339 BROADWAY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1839
Practice Address - Country:US
Practice Address - Phone:617-276-5964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health