Provider Demographics
NPI:1093140691
Name:YBARRA, PRISCILLA VERONICA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:VERONICA
Last Name:YBARRA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 WRIGHT AVE APT B
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-1256
Mailing Address - Country:US
Mailing Address - Phone:501-412-0102
Mailing Address - Fax:
Practice Address - Street 1:715 WRIGHT AVE APT B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-1256
Practice Address - Country:US
Practice Address - Phone:501-412-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6972-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker