Provider Demographics
NPI:1740312958
Name:YBARRA, JACINTO ROBERT (LCSW)
Entity type:Individual
Prefix:
First Name:JACINTO
Middle Name:ROBERT
Last Name:YBARRA
Suffix:
Gender:M
Credentials:LCSW
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 725
Mailing Address - Street 2:19965 FM 3175 N.
Mailing Address - City:LYTLE
Mailing Address - State:TX
Mailing Address - Zip Code:78052-0725
Mailing Address - Country:US
Mailing Address - Phone:210-357-0369
Mailing Address - Fax:210-357-0458
Practice Address - Street 1:1005 B ST
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-1900
Practice Address - Country:US
Practice Address - Phone:830-216-4326
Practice Address - Fax:830-216-4881
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS242041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B7954Medicare ID - Type Unspecified