Provider Demographics
NPI:1639851405
Name:IBARRA, MARIA (LMSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:IBARRA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3039
Mailing Address - Country:US
Mailing Address - Phone:573-840-0440
Mailing Address - Fax:870-324-5121
Practice Address - Street 1:103 S MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3039
Practice Address - Country:US
Practice Address - Phone:573-840-0440
Practice Address - Fax:870-324-5121
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023030321104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker