Provider Demographics
NPI:1184964363
Name:BIBBENS, ROSALIND JEWELL (MSW,LCSW APPLICANT)
Entity type:Individual
Prefix:MS
First Name:ROSALIND
Middle Name:JEWELL
Last Name:BIBBENS
Suffix:
Gender:F
Credentials:MSW,LCSW APPLICANT
Other - Prefix:MS
Other - First Name:ROSALIND
Other - Middle Name:JEWELL
Other - Last Name:ESTES-BIBBENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:160 E VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5857
Mailing Address - Country:US
Mailing Address - Phone:831-238-7826
Mailing Address - Fax:408-998-1535
Practice Address - Street 1:160 E VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5857
Practice Address - Country:US
Practice Address - Phone:831-392-1500
Practice Address - Fax:831-392-1501
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105997101YM0800X, 104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health