Provider Demographics
NPI:1346426186
Name:FONTAINE-YBARRA, MICHELLE R (LMSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:FONTAINE-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 1:992 N KIRBY ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2209
Mailing Address - Country:US
Mailing Address - Phone:480-832-2150
Mailing Address - Fax:
Practice Address - Street 1:992 N KIRBY ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2209
Practice Address - Country:US
Practice Address - Phone:480-832-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-116591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical