Provider Demographics
NPI:1861625584
Name:IBARRA, NICOLE ELIZABETH (MFT)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:IBARRA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2305
Mailing Address - Country:US
Mailing Address - Phone:415-580-9541
Mailing Address - Fax:
Practice Address - Street 1:202 E BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2305
Practice Address - Country:US
Practice Address - Phone:415-580-9541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65294106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist