Provider Demographics
NPI:1205573227
Name:YBARRA, JENNIFER MARIE (MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:YBARRA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JENNEVIEVE
Other - Middle Name:MARIE
Other - Last Name:YBARRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 1402
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-1402
Mailing Address - Country:US
Mailing Address - Phone:808-517-5214
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1402
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-1402
Practice Address - Country:US
Practice Address - Phone:808-206-9371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health