Provider Demographics
NPI:1689370801
Name:CARRANZA-IBARRA, CECILIA I (LMFT)
Entity Type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:
Last Name:CARRANZA-IBARRA
Suffix:I
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:CECILIA
Other - Middle Name:C
Other - Last Name:IBARRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:211 S PRIMROSE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2856
Mailing Address - Country:US
Mailing Address - Phone:626-509-9452
Mailing Address - Fax:
Practice Address - Street 1:211 S PRIMROSE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2856
Practice Address - Country:US
Practice Address - Phone:626-509-9452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124444106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist