Provider Demographics
NPI:1235693243
Name:IBARRA, SKYLAR MAMIE LENOX (MSW)
Entity Type:Individual
Prefix:
First Name:SKYLAR
Middle Name:MAMIE LENOX
Last Name:IBARRA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9909 TOPANGA CANYON BLVD # 272
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3602
Mailing Address - Country:US
Mailing Address - Phone:818-416-4094
Mailing Address - Fax:
Practice Address - Street 1:4325 W SUNSET BLVD STE 206
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2180
Practice Address - Country:US
Practice Address - Phone:310-388-7983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA682751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical