Provider Demographics
NPI:1871790121
Name:SIBILLA, WARREN WILLIAM JR (PHD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:WILLIAM
Last Name:SIBILLA
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:105 E JEFFERSON BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1922
Mailing Address - Country:US
Mailing Address - Phone:574-232-4453
Mailing Address - Fax:574-232-7718
Practice Address - Street 1:105 E JEFFERSON BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1922
Practice Address - Country:US
Practice Address - Phone:574-232-4453
Practice Address - Fax:574-232-7718
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
102L00000X
IN20040799103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical