Provider Demographics
NPI:1679901300
Name:GEORGIANNA, SIBYLLE (PHD)
Entity type:Individual
Prefix:DR
First Name:SIBYLLE
Middle Name:
Last Name:GEORGIANNA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 TERRA VIS
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3130
Mailing Address - Country:US
Mailing Address - Phone:917-620-0481
Mailing Address - Fax:
Practice Address - Street 1:40 TERRA VIS
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3130
Practice Address - Country:US
Practice Address - Phone:917-620-0481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25902103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical