Provider Demographics
NPI:1376344408
Name:IBANEZ VERA, CARLOS AGUSTIN (CBHCM-S)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:AGUSTIN
Last Name:IBANEZ VERA
Suffix:
Gender:M
Credentials:CBHCM-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3427 SW 7TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5330
Mailing Address - Country:US
Mailing Address - Phone:786-203-9232
Mailing Address - Fax:
Practice Address - Street 1:3427 SW 7TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-5330
Practice Address - Country:US
Practice Address - Phone:786-203-9232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker