Provider Demographics
NPI:1073084232
Name:KABARA, SYBIL ERIN (MS, SST)
Entity Type:Individual
Prefix:
First Name:SYBIL
Middle Name:ERIN
Last Name:KABARA
Suffix:
Gender:F
Credentials:MS, SST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21885 DUNHAM RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1030
Mailing Address - Country:US
Mailing Address - Phone:586-469-5950
Mailing Address - Fax:586-469-6637
Practice Address - Street 1:21885 DUNHAM RD STE 1
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1030
Practice Address - Country:US
Practice Address - Phone:586-469-5950
Practice Address - Fax:586-469-6637
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI6803087135171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1073084232Medicaid