Healthcare Provider Details

I. General information

NPI: 1467499491
Provider Name (Legal Business Name): KATHLEEN VANBIBBER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 N EL MOLINO AVE #2
PASADENA CA
91101-1403
US

IV. Provider business mailing address

447 N EL MOLINO AVE #2
PASADENA CA
91101-1403
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-8480
  • Fax: 626-577-8978
Mailing address:
  • Phone: 626-577-8480
  • Fax: 626-577-8978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS21721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: