Healthcare Provider Details

I. General information

NPI: 1396187928
Provider Name (Legal Business Name): DONNA VIBES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 07/18/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 165
OXNARD CA
93036-2612
US

IV. Provider business mailing address

3701 VIA MARINA AVE
OXNARD CA
93035-2220
US

V. Phone/Fax

Practice location:
  • Phone: 860-830-5371
  • Fax:
Mailing address:
  • Phone: 860-830-5371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number008281
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: