Provider Demographics
NPI:1588208110
Name:STIBBINS, RONIKA DARLENE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:RONIKA
Middle Name:DARLENE
Last Name:STIBBINS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 MAPLE HILLS DR APT H
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55117-7300
Mailing Address - Country:US
Mailing Address - Phone:651-497-1388
Mailing Address - Fax:
Practice Address - Street 1:475 CLEVELAND AVE N STE 305&316
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5031
Practice Address - Country:US
Practice Address - Phone:651-330-3434
Practice Address - Fax:651-330-3581
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN219981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical