Provider Demographics
NPI:1063435279
Name:LOEBL, RICHARD J (LCSW, BCD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:LOEBL
Suffix:
Gender:M
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 NW 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-8013
Mailing Address - Country:US
Mailing Address - Phone:561-955-6090
Mailing Address - Fax:
Practice Address - Street 1:7284 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3406
Practice Address - Country:US
Practice Address - Phone:561-955-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW60251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0801Medicare ID - Type Unspecified