Provider Demographics
NPI:1518199678
Name:ULIBARRI, FERMAN (LMSW, LSAA)
Entity Type:Individual
Prefix:MR
First Name:FERMAN
Middle Name:
Last Name:ULIBARRI
Suffix:
Gender:M
Credentials:LMSW, LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LETTON DR
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-4366
Mailing Address - Country:US
Mailing Address - Phone:575-445-8568
Mailing Address - Fax:575-445-0540
Practice Address - Street 1:101 LETTON DR
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-4366
Practice Address - Country:US
Practice Address - Phone:575-445-8568
Practice Address - Fax:575-445-0540
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0090011101YA0400X
NMM-41771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM71525564Medicaid