Provider Demographics
NPI:1952466880
Name:LYBARGER, MARTHA ANN (MFT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:LYBARGER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FUNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2107
Mailing Address - Country:US
Mailing Address - Phone:415-522-9050
Mailing Address - Fax:415-664-3743
Practice Address - Street 1:1300 FUNSTON AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2107
Practice Address - Country:US
Practice Address - Phone:415-522-9050
Practice Address - Fax:415-664-3743
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33547106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist