Provider Demographics
NPI:1144627662
Name:IBARRA, MARIBEL BRAVO (LCSW, PPS)
Entity type:Individual
Prefix:MS
First Name:MARIBEL
Middle Name:BRAVO
Last Name:IBARRA
Suffix:
Gender:F
Credentials:LCSW, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8238 SINNARD AVE
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:CA
Mailing Address - Zip Code:95953-9625
Mailing Address - Country:US
Mailing Address - Phone:530-828-1552
Mailing Address - Fax:
Practice Address - Street 1:390 RIO LINDO AVE APT 34
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1936
Practice Address - Country:US
Practice Address - Phone:530-828-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA1155801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker