Provider Demographics
NPI:1851672307
Name:MARINO-KIBBEE, BIXBY (LCSW)
Entity Type:Individual
Prefix:
First Name:BIXBY
Middle Name:
Last Name:MARINO-KIBBEE
Suffix:
Gender:X
Credentials:LCSW
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:BIXBY
Other - Last Name:MARINO-KIBBEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3020 CHILDRENS WAY # MC5165
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-966-8493
Mailing Address - Fax:
Practice Address - Street 1:8110 BIRMINGHAM WAY BLDG 28
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2758
Practice Address - Country:US
Practice Address - Phone:858-966-8493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW644591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical