Individual
LAURA SUSAN DIBBLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
555 WARREN RD, TST BOCES, ITHACA, NY 14850-1862
(315) 253-9795
(315) 253-3255
Mailing address
PO BOX 295, MANLIUS, NY 13104-0295
(315) 420-3030
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
204383
NY
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
204383
NY
Other
Enumeration date
08/01/2006
Last updated
01/09/2014
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