Provider Demographics
NPI:1417458738
Name:IBARRA, RICHARD (LMSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:IBARRA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 FIVE POINTS RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-3179
Mailing Address - Country:US
Mailing Address - Phone:505-349-8486
Mailing Address - Fax:
Practice Address - Street 1:1528 FIVE POINTS RD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-3179
Practice Address - Country:US
Practice Address - Phone:505-349-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-101101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical