Provider Demographics
NPI:1316155609
Name:TYBL, JOSEF F (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEF
Middle Name:F
Last Name:TYBL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 GREENTREE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-3239
Mailing Address - Country:US
Mailing Address - Phone:412-921-2325
Mailing Address - Fax:412-341-6963
Practice Address - Street 1:990 GREENTREE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-3239
Practice Address - Country:US
Practice Address - Phone:412-921-2325
Practice Address - Fax:412-341-6963
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005444-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAIP134758OtherMBH
PA166787OtherVALUE OPTIONS
PA716118OtherHIGHMARK BLUE SHIELD
PA34568SOtherCAQH
PA212214OtherMHN
PA41-01435862Medicaid
PA174234OtherGREAT WEST
PA34568SOtherCAQH