Provider Demographics
NPI:1851056964
Name:YBARRA-ROJAS, AMY CASTRILLO (GRADUATE STUDENT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:CASTRILLO
Last Name:YBARRA-ROJAS
Suffix:
Gender:F
Credentials:GRADUATE STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-2923
Mailing Address - Country:US
Mailing Address - Phone:925-341-9658
Mailing Address - Fax:
Practice Address - Street 1:408 E PINE ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-2923
Practice Address - Country:US
Practice Address - Phone:925-341-9658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health