Provider Demographics
NPI:1346442605
Name:SHIBATA, NANCY CAROL (MA LMFT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:CAROL
Last Name:SHIBATA
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4478 MACBETH CIR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2125
Mailing Address - Country:US
Mailing Address - Phone:510-794-6020
Mailing Address - Fax:
Practice Address - Street 1:39785 PASEO PADRE PKWY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2926
Practice Address - Country:US
Practice Address - Phone:510-794-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33161106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist