Provider Demographics
NPI:1821321910
Name:IBBETSON, LORENE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LORENE
Middle Name:
Last Name:IBBETSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 AVENIDA ENCINAS
Mailing Address - Street 2:SUITE #250
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-4385
Mailing Address - Country:US
Mailing Address - Phone:760-828-8905
Mailing Address - Fax:760-828-8905
Practice Address - Street 1:5315 AVENIDA ENCINAS
Practice Address - Street 2:SUITE #250
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-4385
Practice Address - Country:US
Practice Address - Phone:760-828-8905
Practice Address - Fax:760-828-8905
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 210881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical