Provider Demographics
NPI:1881656486
Name:GIUBARDO, MAYTE IDELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MAYTE
Middle Name:IDELLE
Last Name:GIUBARDO
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Gender:F
Credentials:LCSW
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Mailing Address - Street 1:1743 SYCAMORE AVE
Mailing Address - Street 2:MOHAVE MENTAL HEALTH CLINIC INC
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409
Mailing Address - Country:US
Mailing Address - Phone:928-757-8111
Mailing Address - Fax:928-757-3256
Practice Address - Street 1:1145 MARINA BLVD
Practice Address - Street 2:MOHAVE MENTAL HEALTH CLINIC INC
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442
Practice Address - Country:US
Practice Address - Phone:928-758-5905
Practice Address - Fax:928-757-3256
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZLCSW118551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical