Provider Demographics
NPI:1932241635
Name:IBEABUCHI, GEOFFREY BESTMAN (DR PHD LCSW)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:BESTMAN
Last Name:IBEABUCHI
Suffix:
Gender:M
Credentials:DR PHD 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 264
Mailing Address - Street 2:
Mailing Address - City:PATTON
Mailing Address - State:CA
Mailing Address - Zip Code:92369-0264
Mailing Address - Country:US
Mailing Address - Phone:909-567-2808
Mailing Address - Fax:909-383-4466
Practice Address - Street 1:255 N. D STREET, UNIT 400
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401
Practice Address - Country:US
Practice Address - Phone:909-567-2808
Practice Address - Fax:909-383-4466
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS183571041C0700X
CALCSW183571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical