Provider Demographics
NPI:1134475536
Name:IBARRA, NATHALY GRISELL (MS)
Entity Type:Individual
Prefix:MISS
First Name:NATHALY
Middle Name:GRISELL
Last Name:IBARRA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 3RD CT
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5103
Mailing Address - Country:US
Mailing Address - Phone:954-540-4710
Mailing Address - Fax:
Practice Address - Street 1:2112 S CONGRESS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-7670
Practice Address - Country:US
Practice Address - Phone:561-653-6292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health