Provider Demographics
NPI:1386860179
Name:HYBERTSEN, GAY WILLIS (LC,SW)
Entity Type:Individual
Prefix:MS
First Name:GAY
Middle Name:WILLIS
Last Name:HYBERTSEN
Suffix:
Gender:F
Credentials:LC,SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 CARROLL CANYON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1780
Mailing Address - Country:US
Mailing Address - Phone:858-558-7576
Mailing Address - Fax:858-457-1416
Practice Address - Street 1:5230 CARROLL CANYON RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1780
Practice Address - Country:US
Practice Address - Phone:858-558-7576
Practice Address - Fax:858-457-1416
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS73951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical