| Doctor Name: | DR. MARK DAVID LIBON |
| NPI Number: | 1023036878 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 902 |
| Business Practice Address: | 800 Cummings Ctr Ste 266t Beverly, MA - 019156172 |
| Business Phone Number: | 9789211293 |
| Business Fax Number: | 9789211294 |
| Mailing Address: | Po Box 492, 131 Rantoul Street BEVERLY |
| State: | MA |
| Postal Code: | 019150492 |
| Phone Number: | 9789211293 |
| Fax Number: | 9789211294 |
| NPI Enumeration Date: | 07/18/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 902 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |