Provider Demographics
NPI:1477836476
Name:URIBE, ELEANOR OCTAVIA (LCSW, PPSC)
Entity type:Individual
Prefix:PROF
First Name:ELEANOR
Middle Name:OCTAVIA
Last Name:URIBE
Suffix:
Gender:F
Credentials:LCSW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11303
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93772-1303
Mailing Address - Country:US
Mailing Address - Phone:559-313-1837
Mailing Address - Fax:
Practice Address - Street 1:3097 WILLOW AVE STE 9
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-4715
Practice Address - Country:US
Practice Address - Phone:559-313-1837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical