| Doctor Name: | DR. HERBERT NIEBURG |
| NPI Number: | 1407831670 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 000880 |
| Business Practice Address: | 185 S Broad St Suite 103 Pawcatuck, CT - 063791997 |
| Business Phone Number: | 8605992125 |
| Business Fax Number: | 4013220883 |
| Mailing Address: | 185 S Broad St, Suite 103 PAWCATUCK |
| State: | CT |
| Postal Code: | 063791997 |
| Phone Number: | 8605992125 |
| Fax Number: | 4013220883 |
| NPI Enumeration Date: | 12/10/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 000880 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |