Provider Demographics
NPI:1295152544
Name:RABANAL, IVETTE Y (LCSW, LADAC)
Entity type:Individual
Prefix:MS
First Name:IVETTE
Middle Name:Y
Last Name:RABANAL
Suffix:
Gender:F
Credentials:LCSW, LADAC
Other - Prefix:
Other - First Name:IVETTE
Other - Middle Name:
Other - Last Name:BIBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3350 S LAKESIDE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-2736
Mailing Address - Country:US
Mailing Address - Phone:505-203-5983
Mailing Address - Fax:
Practice Address - Street 1:618 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-2721
Practice Address - Country:US
Practice Address - Phone:928-362-7343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-155264101YA0400X
NM0128951101YA0400X
NMI-071811041C0700X
AZLCSW-207601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)